Real-world outcomes of second-line therapy in advanced thymic carcinoma: a multicenter Turkish Oncology Group (TOG) study

Abstract Background Thymic carcinoma (TC) is a rare and aggressive malignancy with limited evidence guiding second-line treatment after prior systemic therapy. We evaluated real-world outcomes of second-line systemic therapy in a multicenter cohort. Methods Adults with unresectable, recurrent, or metastatic TC who received second-line systemic therapy after prior systemic therapy between 2010 and 2023 were retrospectively analyzed. Treatments were categorized as multidrug chemotherapy, gemcitabine monotherapy, PD-1 inhibitor therapy, or targeted therapy (sunitinib). For the primary comparison of multidrug chemotherapy versus gemcitabine monotherapy, propensity scores based on age, sex, ECOG performance status, Masaoka–Koga stage IV, prior surgery, and calendar year were used to generate overlap weights. Weighted Cox models used robust standard errors clustered by treatment center. A sensitivity propensity-score model additionally included first-line carboplatin–paclitaxel exposure (yes/no). Results A total of 107 patients from 20 treatment centers were included. Median age was 53.2 years (IQR, 41.5–58.0), 78 (72.9%) were male, 81 of 106 patients with available data (76.4%) had ECOG 0–1, and 61 (57.0%) had Masaoka–Koga stage IV disease at diagnosis. At a median follow-up of 35 months, median PFS and OS for the overall cohort were 13.6 and 35.0 months, respectively. In the primary overlap-weighted comparison ( n = 89), multidrug chemotherapy was associated with a lower hazard of progression or death than gemcitabine monotherapy (HR, 0.29; 95% CI, 0.14–0.59; p < 0.001) and a lower hazard of death (HR, 0.42; 95% CI, 0.18–0.97; p = 0.043). In a sensitivity model additionally incorporating first-line carboplatin–paclitaxel exposure, the PFS estimate remained significant (HR, 0.32; 95% CI, 0.16–0.65; p = 0.0015), whereas the OS estimate remained directionally similar but was less precise (HR, 0.46; 95% CI, 0.19–1.11; p = 0.083). The PD-1 inhibitor group ( n = 13) had median PFS and OS of 15.0 and 48.0 months, respectively, in unadjusted descriptive analyses. Conclusions In this retrospective cohort, multidrug chemotherapy was associated with lower hazards of progression or death and of death than gemcitabine monotherapy in the primary overlap-weighted analysis. A sensitivity analysis additionally accounting for first-line carboplatin–paclitaxel exposure preserved the PFS association and yielded a similar but less precise OS estimate. Outcomes observed with PD-1 inhibitors were favorable but should be interpreted descriptively because of the small sample size, later treatment era, and potential residual confounding. These findings are hypothesis-generating and require prospective validation.

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Journal
BMC Cancer
Published
2026-08-27
DOI
https://doi.org/10.1186/s12885-026-16868-5
Primary Topic
Myasthenia Gravis and Thymoma
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article

Real-world outcomes of second-line therapy in advanced thymic carcinoma: a multicenter Turkish Oncology Group (TOG) study

Şendağ Yaslıkaya, Ilgın Koç Kuş, Damla Günenç, Nigar Rustamova Cennet et al.
BMC Cancer
Myasthenia Gravis and Thymoma
article

Real-world outcomes of second-line therapy in advanced thymic carcinoma: a multicenter Turkish Oncology Group (TOG) study

Şendağ Yaslıkaya, Ilgın Koç Kuş, Damla Günenç, Nigar Rustamova Cennet, Saadettin Kılıçkap, Abdüssamet Çelebi, Murad Guliyev, Erkut Demırcıler, Mert Erciyestepe, Goncagül Akdağ, Derya Kıvrak Salim, Alper Topal, Mustafa Erman, Serdar Karakaya, Nebi Serkan Demirci, Fatih Kuş, Hasan Çağrı Yıldırım, Doğan Bayram, Öztürk Ateş, Melike Özçelik, Fatih Atalah, Yakup Düzköprü, Melek Karakurt Eryılmaz, Ömer Denizhan Tatar, Abdullah Sakin, Gözde Ağdaş, Caner Kapar, İlknur Deliktaş Onur, Gökhan Şahin, Fırat Şirvan, Taliha Guclu, Harun Muglu, Ayşegül Merç Çetinkaya, Pinar Gursoy, Mehmet Ali Şendur, Elif Sahin, Halil Göksel Güzel, Ozlem Er, Ahmet Bilici, Omer Faruk Elcicek, Bilgesah Kilictas, Irem Ugurlu, Gamze Gokoz Dogu
article en

Abstract

Abstract Background Thymic carcinoma (TC) is a rare and aggressive malignancy with limited evidence guiding second-line treatment after prior systemic therapy. We evaluated real-world outcomes of second-line systemic therapy in a multicenter cohort. Methods Adults with unresectable, recurrent, or metastatic TC who received second-line systemic therapy after prior systemic therapy between 2010 and 2023 were retrospectively analyzed. Treatments were categorized as multidrug chemotherapy, gemcitabine monotherapy, PD-1 inhibitor therapy, or targeted therapy (sunitinib). For the primary comparison of multidrug chemotherapy versus gemcitabine monotherapy, propensity scores based on age, sex, ECOG performance status, Masaoka–Koga stage IV, prior surgery, and calendar year were used to generate overlap weights. Weighted Cox models used robust standard errors clustered by treatment center. A sensitivity propensity-score model additionally included first-line carboplatin–paclitaxel exposure (yes/no). Results A total of 107 patients from 20 treatment centers were included. Median age was 53.2 years (IQR, 41.5–58.0), 78 (72.9%) were male, 81 of 106 patients with available data (76.4%) had ECOG 0–1, and 61 (57.0%) had Masaoka–Koga stage IV disease at diagnosis. At a median follow-up of 35 months, median PFS and OS for the overall cohort were 13.6 and 35.0 months, respectively. In the primary overlap-weighted comparison ( n = 89), multidrug chemotherapy was associated with a lower hazard of progression or death than gemcitabine monotherapy (HR, 0.29; 95% CI, 0.14–0.59; p < 0.001) and a lower hazard of death (HR, 0.42; 95% CI, 0.18–0.97; p = 0.043). In a sensitivity model additionally incorporating first-line carboplatin–paclitaxel exposure, the PFS estimate remained significant (HR, 0.32; 95% CI, 0.16–0.65; p = 0.0015), whereas the OS estimate remained directionally similar but was less precise (HR, 0.46; 95% CI, 0.19–1.11; p = 0.083). The PD-1 inhibitor group ( n = 13) had median PFS and OS of 15.0 and 48.0 months, respectively, in unadjusted descriptive analyses. Conclusions In this retrospective cohort, multidrug chemotherapy was associated with lower hazards of progression or death and of death than gemcitabine monotherapy in the primary overlap-weighted analysis. A sensitivity analysis additionally accounting for first-line carboplatin–paclitaxel exposure preserved the PFS association and yielded a similar but less precise OS estimate. Outcomes observed with PD-1 inhibitors were favorable but should be interpreted descriptively because of the small sample size, later treatment era, and potential residual confounding. These findings are hypothesis-generating and require prospective validation.

BMC Cancer
Tekirdağ Namık Kemal University (TR), Bahçeşehir University (TR), Bilkent University (TR), Dokuz Eylül University (TR), Acıbadem University (TR), Ege University (TR), Gülhane Askerî Tıp Akademisi (TR), Ankara Atatürk Eğitim ve Araştırma Hastanesi (TR), Memorial Ankara Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Necmettin Erbakan University (TR), Ankara Onkoloji Eğitim ve Araştırma Hastanesi (TR), Akdeniz University Hospital (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Hacettepe University Hospital (TR), Bakırköy Dr.Sadi Konuk Eğitim ve Araştırma Hastanesi (TR), Istanbul Eye Hospital (TR), Liv Hospital (TR), Antalya IVF (TR), Pamukkale University (TR), Eskişehir Osmangazi University (TR), Kocaeli Üniversitesi (TR), Cukurova University (TR), Hacettepe University (TR), Istanbul University (TR), Marmara University (TR), Gazi University (TR)
Good health and well-being
Openalex Percentile: Top 10%
Myasthenia Gravis and Thymoma
DOIOpen Access PDFOpenAlex
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