Background: We describe three cases of thymic epithelial tumors (TET) heavily pretreated, which responded to oral etoposide, after progression to everolimus.
Methods: The first patient is a 50-year-old woman with a diagnosis of squamous thymic carcinoma from April 2006, judged inoperable. The second patient is a 51-year-old woman, with diagnosis of thymoma B2/B3 from June 2004, who progressed after radical surgery. The third patient is a 40-year-old man, with diagnosis of functional neuroendocrine thymic carcinoma, discovered for an associated Cushing Syndrome ACTH dependent, went to no radical surgery. All of them had TET stage IVb sec Masaoka-Koga. The first line platinum based plus anthracycline chemotherapy was administrated, after they received single agent octreotide LAR as maintenance treatment due to the positivity of OctreoScan. At progression they underwent to a series of other several treatments as: gemcitabine plus capecitabine and everolimus. In the first and third patient everolimus was administrated in association with somatostatin analogs, obtaining respectively a PFS of 31 and 6 months. In the second patient indeed, it was administrated alone, obtaining a PFS of 4 months. After progression, all of them received oral etoposide at dose of 50 mg daily 3-week on/1 week off.
Results: All the patients showed the best response disease, assessed with a CT scan total body, to oral etoposide as sixth line of systemic therapy, after progressed to everolimus. Specifically, they are still on treatment and the time to progression has not been reached.
Conclusions: Our experience of long lasting management of advanced relapsed TET can prove how the chemosensitivity in this setting of patients has been restored after the administration of biological agents. Further studied are needed to investigate the biological modification of TETs due to this sequence of treatment.
