{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:03:38Z","timestamp":1785225818526,"version":"3.55.0"},"reference-count":108,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Thymic epithelial tumors (TETs), comprising thymomas and thymic carcinomas, are rare, biologically heterogeneous thoracic malignancies with limited therapeutic advances since platinum-based regimens were adopted decades ago. Recent genomic and immunophenotypic profiling has uncovered recurrent genomic alterations and high programmed death-ligand 1 (PD-L1) expression, particularly in thymic carcinoma, yet few targeted or immunotherapies have achieved regulatory approval. This mini-review synthesizes current knowledge on TET heterogeneity and the genomic landscape, evaluates the clinical evidence supporting targeted agents and immune checkpoint inhibitors, and examines emerging biomarkers, including circulating tumor DNA. We also address practical barriers to precision oncology in TETs: challenges of next-generation sequencing implementation and cost in resource-limited settings; scarcity of large, biomarker-driven trials; and safety concerns unique to TETs (immune-related toxicity). Finally, we discuss the translational hurdles for antibody\u2013drug conjugates and cellular therapies, limited validated cell surface targets, antigen heterogeneity, and preclinical model gaps and outline strategic paths forward to enable rational, safe, and equitable precision therapeutics for TET patients.<\/jats:p>","DOI":"10.3390\/ijms27156613","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"6613","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Precision Oncology in Thymic Epithelial Tumors: Therapeutic Horizons and Implementation Barriers"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7705-3926","authenticated-orcid":false,"given":"K\u00fcbra","family":"Canaslan","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Mehmet Akif \u0130nan Research and Training Hospital, \u015eanl\u0131urfa 63040, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0684-8710","authenticated-orcid":false,"given":"\u00d6zge","family":"Yetgino\u011flu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Dokuz Eyl\u00fcl University, \u0130zmir 35330, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8836-1027","authenticated-orcid":false,"given":"Yasuhiro","family":"Tsutani","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka 589-0014, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Cancer Institute (Jhajjar)-AIIMS, New Delhi 124105, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7011-7276","authenticated-orcid":false,"given":"Daniel E.","family":"Mansila","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Instituto de Oncologia Angel H. Roffo, Buenos Aires C1417DTB, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Emami","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran 1416634793, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Abolhassani","sequence":"additional","affiliation":[{"name":"Clinic for Pediatric Immunology and Rheumatology, Center for Pediatrics and Adolescent Medicine, University Hospital Bonn, 53127 Bonn, Germany"},{"name":"Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children\u2019s Medical Center, Tehran University of Medical Sciences, Tehran 1419733151, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Ardeshir-Larijani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cancer Institute, Tehran University of Medical Sciences (TUMS), Tehran 1416634793, Iran"},{"name":"Research Institute for Oncology\/Hematology and Cell Therapy (RIOHCT), Tehran University of Medical Sciences (TUMS), Tehran 1411713135, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/S1470-2045(17)30445-X","article-title":"Burden and centralised treatment in Europe of rare tumours: Results of RARECAREnet\u2014A population-based study","volume":"18","author":"Gatta","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7531","DOI":"10.21037\/jtd-2019-thym-02","article-title":"Epidemiology of thymoma","volume":"12","author":"Rich","year":"2020","journal-title":"J. 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