Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
was seen in both pre- and post-treatment biopsies. The immune infiltrate
consisted of immature T cells in pre-treatment tumor samples in both cases.
The post-treatment biopsy showed continued presence of immature T cells
in one case and a mature CD8+ T cell phenotype in the other case. Decreased
CTLA4+ regulatory T cells and decreased ratio of granulocytic vs. monocytic
myeloid-derived suppressor cells was seen post-treatment at the 20mg/kg
dose. Conclusion: Avelumab is active in patients with recurrent thymoma.
Strategies need to be developed to reduce the risk of development of irAEs in
response to immune checkpoint inhibitor therapy in patients with thymoma.
Keywords: immune checkpoint inhibitor, Thymoma, avelumab
OA18: NEW INSIGHTS IN THE TREATMENT OF THYMIC MALIGNANCIES
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA18.05 FDG-PET IN THYMIC EPITHELIAL TUMORS: AN
EVALUATION OF ONLY RESECTED TUMORS
Kazuo Nakagawa 1 , Shoji Takahashi 2 , Yasuhisa Ohde 2 , Hiroaki Kurihara 3 ,
Takashi Terauchi 4
1 Thoracic Surgery, National Cancer Center Hospital, Tokyo/Japan, 2 Thoracic Surgery,
Shizuoka Cancer Center, Shizuoka/Japan, 3 Diagnostic Radiology, National Cancer
Center Hospital, Tokyo/Japan, 4 Nuclear Medicine, Cancer Institute Hospital of
Japanese Foundation for Cancer Research, Tokyo/Japan
Background: 18 F-Fluorodeoxy glucose positron emission tomography (FDG-
PET) is thought to be useful for predicting the histologic grade in thymic
epithelial tumors (TETs). Although there have been many reports on the
use of FDG-PET for evaluating TETs, no previous studies have included only
resected cases. Therefore, we investigated the relationship between the
degree of FDG-uptake in the tumor and either the WHO histologic subtype or
the tumor stage in patients with resected TETs. Methods: We retrospectively
reviewed FDG-PET findings in 112 patients with TETs (92 with thymomas
and 20 with thymic carcinomas) resected at 2 institutes in Japan. The
Spearman rank correlation coefficient was used to assess the association
between the maximum standardized uptake value (SUV max) in the tumor
and both the histologic subtype and tumor stage. The cut-off value of SUV
max for differentiating thymoma from thymic carcinoma was calculated
using a receiver operating characteristic (ROC) curve analysis. Results: The
Table shows the relationship between SUV max in the tumor and the WHO
histologic subtype. SUV max according to each tumor stage was 3.9 ± 1.7
(mean ± SD) in stage I (n = 89), 4.7 ± 1.7 in stage II (n = 3), 7.4 ± 5.3 in stage III
(n =11), and 7.6 ± 3.9 in stage IV (n = 9). SUV max was strongly related to both
the WHO histologic subtype and tumor stage (Spearman rank correlation
coefficient = 0.485 and 0.432; p = 0.000 and 0.000, respectively). The optimal
cut-off value of SUV max for differentiating thymoma from thymic carcinoma
was 4.6, with a sensitivity of 80% and a specificity of 70%.
SUV max
Histologic subtype No. of patients Mean ± SD Range
A 12 3.5 ± 1.3 1.3 – 6.3
AB 45 3.5 ± 1.3 1.2 – 6.9
B1 19 4.1 ± 0.9 2.5 – 6.5
B2 10 4.2 ± 1.0 2.7 – 5.9
B3 6 4.8 ± 2.6 2.4 – 8.6
Thymic carcinoma 20 8.0 ± 4.7 3.0 – 21.8
Total 112 4.5 ± 2.8 1.2 – 21.8
Conclusion: Our results suggest that FDG-PET is useful for differentiating
thymoma from thymic carcinoma. Further studies will be needed to assess
other potential clinical applications of FDG-PET for the evaluation of TETs.
Keywords: FDG-PET, Thymic epithelial tumors, WHO histologic subtype
OA18: NEW INSIGHTS IN THE TREATMENT OF THYMIC MALIGNANCIES
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA18.06 TREATMENT, OUTCOME AND PROGNOSTIC FACTORS
OF PATIENTS WITH THYMIC EPITHELIAL TUMORS AT FIRST
RECURRENCE
Giuseppe Banna 1 , Ankur Sheel 2 , Varun Sheel 3 , Andrea Bille 4 , Tom Routledge 4 ,
Shalini Fernando 4 , Arjun Nair 4 , Rohit Lal 4
1 Division of Medical Oncology, Cannizzaro Hospital, Catania/Italy, 2 Department of
Medicine, University of Massachusetts School of Medicine, Worcester/MA/United
States of America, 3 Department of Biology, University of Massachusetts Amherst,
Amherst/MA/United States of America, 4 Medical Oncology Department, Guy’s
Cancer Centre, London/United Kingdom
Background: The treatment of patients with recurrent thymic tumors remains
uncertain due to limited data because of the rare nature of this disease. This
retrospective analysis was conducted to investigate clinical characteristics,
outcomes and possible prognostic factors of patients presenting with a first
recurrence of thymic tumors. Methods: 107 patients with thymic neoplasms
registered as C37 by ICD10 coding at Guy’s Hospital during the 2007-2016
period with first recurrence following primary treatment were selected and
retrospectively reviewed via descriptive analysis. Differences in survival were
assessed using Kaplan-Meier analysis and uni & multivariate Cox proportional
hazards regression analyses. Results: 25 patients (14 male & 11 female) with
a median age of 51 years (range 36-80 years) experienced a first recurrence of
thymoma (20 patients – 80%) or thymic carcinoma (5 patients – 20%) with a
median time from diagnosis of 36 months (range, 7-270). At diagnosis, modified
Masaoka disease stage was IIA/IIB/IIIA/IIIB/IVA/IVB in 4/0/8/2/6/5 patients; 18
patients’ (72%) primary resection was R0/R1/R2 in 11/3/4 patients; 9 patients
(36%) received radiotherapy; 19 received chemotherapy (76%); CAP (n=10)
and platinum-etoposide (n=6) regimens. At first relapse, 19 patients (76%)
had thoracic recurrence and 6 patients (24%) extrathoracic recurrence. Nine
patients (26%) underwent redo surgery, 3 of which recieved chemotherapy
prior to resection. Overall resection status was 2/5/1 (1 patient’s data is not
yet assessable) R0/R1/R2. Chemotherapy was administered in 17 patients
(68%) with a median cycle of 4 (range, 1-6): 16 patients received combination
chemotherapy consisting of platinum etoposide (n=10) or cisplatinanthracycline
based (CAP/CAV/AC n=5). Dose reduction and withdrawal
were reported in 3 (18%) and 7 (41%) patients, respectively. In 4 out of these
7 patients withdrawal was due to PD; disease control rate (=CR+PR+SD)
was 67% (in 10 out of 15 assessable patients). Three patients (12%) received
radiotherapy of which one was treated exclusively with radiotherapy. Time
to progression since the first recurrence was 12 months (range 2-52 months);
in 16 patients extrathoracic recurrence was seen in 4 patients (25%) and
thoracic in 12 patients (75%). Eight recurring patients (50%) received further
chemotherapy. With a median follow-up of 32.5 months, 19 patients (75%) are
alive and 2 (8%) disease-free; median OS has not been reached, median PFS was
29.5 months (range, 26.3-33.2). Analysis of possible prognostic factors will be
presented. Conclusion: Patients with first recurrence of thymic tumors may
benefit from combination chemotherapy and surgery when feasible.
Keywords: relapse, treatment, Thymoma, Thymic carcinoma
OA18: NEW INSIGHTS IN THE TREATMENT OF THYMIC MALIGNANCIES
WEDNESDAY, DECEMBER 7, 2016 - 11:00-12:30
OA18.07 QUALITY OF RESECTION AND OUTCOME IN STAGE III TETS:
THE FRENCH RYTHMIC NETWORK EXPERIENCE
Maria Bluthgen 1 , Eric Dansin 2 , Dan Ou 3 , Hervé Léna 4 , Julien Mazieres 5 , Eric
Pichon 6 , François Thillays 7 , Gilbert Massard 8 , Xavier Quantin 9 , Youssef
Oulkhouir 10 , Thierry Nguyen 11 , Luc Thiberville 12 , Christelle Clément-Duchêne 13 ,
Colin Lindsay 1 , Pascale Missy 14 , Thierry Molina 15 , Nicolas Girard 16 , Benjamin
Besse 17 , Pascal Alexandre Thomas 18
1 Cancer Medicine, Gustave Roussy, Villejiuf/France, 2 Département de Cancérologie
Générale, Centre Oscar Lambret, Lille/France, 3 Department of Radiation Oncology,
Gustave Roussy, Villejiuf/France, 4 CHU Rennes - Hôpital Pontchaillou, Rennes/
France, 5 Hôpital Rangueil, Toulouse/France, 6 CHU Tours-Bretonneau, Tours/France,
7 Institut de Cancérologie de L’Ouest, St. Herblain/France, 8 University Hospital,
Strasbourg/France, 9 University Hospital, Montpellier/France, 10 University Hospital,
Caen/France, 11 Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz,
Besançon/France, 12 Centre Hospitalier Universitaire, Rouen/France, 13 Cancer
Center, Nancy/France, 14 French Cooperative Thoracic Intergroup (IFCT), Paris/
France, 15 University Hospital Necker, Paris/France, 16 Thoracic Oncology, Hospices
Civils de Lyon, Lyon/France, 17 Department of Cancer Medicine, Gustave Roussy,
Villejiuf/France, 18 University Hospital, Marseille/France
Background: Stage III TET represents a heterogeneous population and
their optimal approach remains unclear; most of the available literature is
composed of small series spanned over extended periods of time. RYTHMIC
(Réseau tumeurs THYMiques et Cancer) is a French nationwide network for
TET with the objective of territorial coverage by regional expert centers and
systematic discussion of patients management at national tumor board.
We reviewed our experience in stage III thymic tumors in order to evaluate
the value of tumor board recommendations and multidisciplinary approach.
Methods: We conducted a retrospective analysis of patients (pts) with stage
III TET discussed at the RYTHMIC tumor board from January 2012 to December
2015. Clinical, pathologic and surgical data were prospectively collected in
a central database. Survival rates were based on Kaplan-Meier estimation.
Cox proportional hazard models were used to evaluate prognostic factors
for disease free survival (DFS) and overall survival (OS). Results: 150 pts
were included in the analysis. Median age was 64 years [18 – 91], 56% males,
thymoma A-B2/ B3-thymic carcinoma in 52% and 47% respectively; 12%
presented with autoimmune disorder (76% myasthenia). Local treatment
was surgery in 134 pts (90%) followed by radiotherapy (RT) in 90 pts; 26 pts
received preoperative chemotherapy (CT). Complete resection rate (R0) was
S160 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017