Amrubicin as Second-line and Beyond Treatment for Platinum-refractory Advanced Thymic Carcinoma

Thymic carcinoma is a rare mediastinal neoplasm, and the prognosis of patients with advanced thymic carcinoma is poor. No standard chemotherapeutic regimen has yet been established for the disease. This is the first report to evaluate the role of amrubicin, a novel anthracycline anticancer drug, in second-line and beyond treatment for patients with platinum-refractory advanced thymic carcinoma. This study was a review of thymic carcinoma patients who had received amrubicin monotherapy between June 2003 and December 2011 for the progression of disease previously treated with platinum-based chemotherapy. Amrubicin was administered at 35 or 40 mg/m(2) for three consecutive days every 3 weeks, until progression. Nine patients with recurrent thymic carcinoma were registered. Their median age was 61 years (range 4572), and the patients included five males and four females. All nine patients had Masaokas Stage IVb disease. There were three squamous cell carcinomas, one adenocarcinoma, one small-cell carcinoma and two other histological types. The mean number of chemotherapy cycles was five (range 213). Grade 3 or higher toxicities included mainly neutropenia (55.5), anemia (25.0) and febrile neutropenia (11.1). No treatment-related deaths were observed. The response rate was 44.4 (95 confidence interval: 1973). The median progression-free survival after the amrubicin monotherapy was 4.9 months, while the median overall survival was 6.4 months. Single-agent amrubicin was found to be potentially useful as second-line and beyond chemotherapy for patients with advanced thymic carcinoma. Further multi-institutional prospective studies are warranted.