{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:40:45Z","timestamp":1791808845207,"version":"4.3.4"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Thymic epithelial tumors (TETs), including thymoma, thymic carcinoma and neuroendocrine tumors, are uncommon tumors that originate from the epithelial cells of the thymus. Nevertheless, despite their rarity, they represent the most common tumor type located in the anterior mediastinum. Therapeutic choices based on staging and histology may include surgery with or without neoadjuvant or adjuvant therapy represented by chemotherapy, radiotherapy or chemo-radiotherapy. For patients with advanced or metastatic TETs, platinum-based chemotherapy remains the standard first-line treatment; however, some new drugs and combinations are currently under evaluation. In any case, proper management of patients with TETs requires a multidisciplinary team approach to personalize care for each patient.<\/jats:p>","DOI":"10.3390\/life13051170","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T01:05:10Z","timestamp":1683853510000},"page":"1170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Current Treatment Approaches for Thymic Epithelial Tumors"],"prefix":"10.3390","volume":"13","author":[{"given":"Alfredo","family":"Tartarone","sequence":"first","affiliation":[{"name":"Department of Onco-Hematology, Division of Medical Oncology, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Lerose","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro Rocco","family":"Lettini","sequence":"additional","affiliation":[{"name":"Unit of Clinical Psychology, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Tartarone","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Humanitas University, 20090 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.ejca.2012.02.047","article-title":"Rare thoracic cancers, including peritoneum mesothelioma","volume":"48","author":"Siesling","year":"2012","journal-title":"Eur. J. Cancer"},{"key":"ref_2","first-page":"v40","article-title":"Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann","volume":"26","author":"Girard","year":"2015","journal-title":"Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Willner, J., Zhou, F., and Moreira, A.L. (2022). Diagnostic challenges in the cytology of thymic epithelial neoplasms. Cancers, 14.","DOI":"10.3390\/cancers14082013"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/JTO.0000000000000482","article-title":"Modified Masaoka stage and size are independent prognostic predictors in thymoma and modified Masaoka stage is superior to histopathologic classifications","volume":"10","author":"Roden","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_5","first-page":"100323","article-title":"Autoimmune disease in patients with advanced thymic epithelial tumors. JTO Clin","volume":"3","author":"Singhal","year":"2022","journal-title":"Res. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ejca.2022.02.011","article-title":"SARS-CoV-2 vaccine in patients with thymic epithelial tumours with and without active or pre-existing autoimmune disorders: Brief report of a TYME network safety analysis","volume":"166","author":"Giugliano","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"810419","DOI":"10.3389\/fonc.2021.810419","article-title":"Imaging evaluation of thymoma and thymic carcinoma","volume":"11","author":"Strange","year":"2022","journal-title":"Front Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.21037\/jtd-21-1948","article-title":"CT-based radiomics analysis for differentiation between thymoma and thymic carcinoma","volume":"14","author":"Ohira","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.athoracsur.2021.03.084","article-title":"CT radiomic features for predicting resectability and TNM staging in thymic epithelial tumors","volume":"113","author":"Mayoral","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2910","DOI":"10.1038\/s41598-023-30041-z","article-title":"Prognostic CT features in patients with untreated thymic epithelial tumors","volume":"13","author":"Dai","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ejca.2020.11.011","article-title":"Impact of expert pathologic review of thymic epithelial tumours on diagnosis and management in a real-life setting: A RYTHMIC study","volume":"143","author":"Molina","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Angirekula, M., Chang, S.Y., Jenkins, S.M., Greipp, P.T., Sukov, W.R., Marks, R.S., Olivier, K.R., Cassivi, S.D., and Roden, A.C. (2022). CD117, BAP1, MTAP, and TdT is a useful immunohistochemical panel to distinguish thymoma from thymic carcinoma. Cancers, 14.","DOI":"10.3390\/cancers14092299"},{"key":"ref_13","unstructured":"World Health Organization (2021). WHO Classification of Tumours Online, Thoracic Tumours-Tumours of the Thymus, World Heath Organization. [5th ed.]. Available online: https:\/\/tumourclassification.iarc.who.int\/chapters\/35."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Brierley, J.D., Gospodarowicz, M.K., and Wittekind, C. (2017). TNM Classification of Malignant Tumours, Wiley Blackwell. [8th ed.].","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S1710","DOI":"10.1097\/JTO.0b013e31821e8cff","article-title":"The Masaoka-Koga stage classification for thymic malignancies: Clarification and definition of terms","volume":"6","author":"Detterbeck","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1245\/s10434-014-4068-9","article-title":"Long-term outcomes after thoracoscopic resection of stage I and II thymoma: A propensity-matched study","volume":"22","author":"Chao","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pastorino, U., Leuzzi, G., Sabia, F., Girotti, P., Duranti, L., Radaelli, S., Fiore, M., Stacchiotti, S., Patrizia, G., and Salvioni, R. Long term outcome of complex surgical resection and reconstruction for rare thoracic cancers. Tumori J., 2023 16, 3008916231154763.","DOI":"10.1177\/03008916231154763"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00432-014-1800-6","article-title":"Key components of chemotherapy for thymic malignancies: A systematic review and pooled analysis for anthracycline-, carboplatin- or cisplatin-based chemotherapy","volume":"141","author":"Okuma","year":"2015","journal-title":"J. Cancer. Res. Clin. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9452","DOI":"10.3390\/curroncol29120743","article-title":"Comparison of efficacy and safety of platinum-based chemotherapy as first-line therapy between B3 thymoma and thymic carcinoma","volume":"29","author":"Hao","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.2217\/fon.14.144","article-title":"Capecitabine plus gemcitabine in thymic epithelial tumors: Final analysis of a Phase II trial","volume":"10","author":"Palmieri","year":"2014","journal-title":"Future Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S1470-2045(14)71181-7","article-title":"Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: An open-label phase 2 trial","volume":"16","author":"Thomas","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.lungcan.2016.04.024","article-title":"Sunitinib in patients with advanced thymic malignancies: Cohort from the French RYTHMIC network","volume":"97","author":"Remon","year":"2016","journal-title":"Lung Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.lungcan.2013.01.003","article-title":"When a thymic carcinoma \u201cbecomes\u201d a GIST","volume":"80","author":"Rossi","year":"2013","journal-title":"Lung Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ejca.2022.07.009","article-title":"Continuous sunitinib schedule in advanced platinum refractory thymic epithelial neoplasms: A retrospective analysis from the ThYmic MalignanciEs (TYME) Italian collaborative group","volume":"174","author":"Antonarelli","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/S1470-2045(20)30162-5","article-title":"Lenvatinib in patients with advanced or metastatic thymic carcinoma (REMORA): A multicentre, phase 2 trial","volume":"21","author":"Sato","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/cncr.33990","article-title":"Resound Trial: A phase 2 study of regorafenib in patients with thymoma (type B2-B3) and thymic carcinoma previously treated with chemotherapy","volume":"128","author":"Perrino","year":"2022","journal-title":"Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1200\/JCO.2006.07.3049","article-title":"Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: Proposal of new computed tomography response criteria","volume":"25","author":"Choi","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1200\/JCO.2017.74.4078","article-title":"Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy","volume":"36","author":"Zucali","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.lungcan.2019.10.016","article-title":"Phase II study of S-1 in patients with previously-treated invasive thymoma and thymic carcinoma: North Japan lung cancer study group trial 1203","volume":"139","author":"Tsukita","year":"2020","journal-title":"Lung Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7418","DOI":"10.1002\/cam4.3385","article-title":"Phase II trial of S-1 treatment as palliative-intent chemotherapy for previously treated advanced thymic carcinoma","volume":"9","author":"Okuma","year":"2020","journal-title":"Cancer Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1186\/s40425-019-0723-9","article-title":"Efficacy and tolerability of anti-programmed death-ligand 1 (PD-L1) antibody (Avelumab) treatment in advanced thymoma","volume":"7","author":"Rajan","year":"2019","journal-title":"J. Immunother. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1200\/JCO.2017.77.3184","article-title":"Pembrolizumab for patients with refractory or relapsed thymic epithelial tumor: An open-label phase II trial","volume":"37","author":"Cho","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1470-2045(18)30062-7","article-title":"Pembrolizumab in patients with thymic carcinoma: A single-arm, single-centre, phase 2 study","volume":"19","author":"Giaccone","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ejca.2019.03.012","article-title":"Single-arm, multicentre, phase II trial of nivolumab for unresectable or recurrent thymic carcinoma: PRIMER study","volume":"113","author":"Katsuya","year":"2019","journal-title":"Eur. J. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ejca.2022.06.059","article-title":"Treatment outcomes and prognosis of immune checkpoint inhibitors therapy in patients with advanced thymic carcinoma: A multicentre retrospective study","volume":"174","author":"Wang","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/S1470-2045(22)00542-3","article-title":"Avelumab plus axitinib in unresectable or metastatic type B3 thymomas and thymic carcinomas (CAVEATT): A single-arm, multicentre, phase 2 trial","volume":"23","author":"Conforti","year":"2022","journal-title":"Lancet Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Song, Z., Lou, G., Wang, Y., Yang, Z., Wang, W., Ji, Y., Chen, S., Xu, C., Hu, X., and Zhang, Y. (2022). Apatinib in patients with recurrent or metastatic thymic epithelial tumor: A single-arm, multicenter, open-label, phase II trial. BMC Med., 20.","DOI":"10.1186\/s12916-022-02361-w"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jtho.2022.10.008","article-title":"A Phase 2 study of palbociclib for recurrent or refractory advanced thymic epithelial tumors (KCSG LU17-21)","volume":"18","author":"Jung","year":"2023","journal-title":"J. Thorac. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1097\/JTO.0000000000000429","article-title":"Diffuse high intensity PD-L1 staining in thymic epithelial tumors","volume":"10","author":"Padda","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E535","DOI":"10.21037\/jtd.2016.06.32","article-title":"Dramatic response to anti-PD-1 therapy in a patient of squamous cell carcinoma of thymus with multiple lung metastases","volume":"8","author":"Yang","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e31873","DOI":"10.1097\/MD.0000000000031873","article-title":"Severe cardiotoxicity in 2 patients with thymoma receiving immune checkpoint inhibitor therapy: A case report","volume":"101","author":"Liu","year":"2022","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e353","DOI":"10.1093\/oncolo\/oyac026","article-title":"Joint-predominant rheumatic complications of immune checkpoint inhibitor therapy in patients with thymic epithelial tumors","volume":"27","author":"Mullenix","year":"2022","journal-title":"Oncologist"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.2217\/imt-2021-0215","article-title":"Fatal toxicity induced by anti-PD-1 immune checkpoint inhibitor in thymic epithelial tumor","volume":"14","author":"Jing","year":"2022","journal-title":"Immunotherapy"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ohm, B., and Jungraithmayr, W. (2022). Balancing the risk of adverse events against the efficacy of immunotherapy in advanced thymic epithelial tumors. Cancers, 15.","DOI":"10.3390\/cancers15010289"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"100392","DOI":"10.1016\/j.xcrm.2021.100392","article-title":"Molecular predictors of response to pembrolizumab in thymic carcinoma","volume":"2","author":"He","year":"2021","journal-title":"Cell Rep. Med."},{"key":"ref_46","unstructured":"(2023, February 20). NCCN Clinical Practice Guidelines in Oncology, Thymomas and Thymic Carcinomas Version 1.2023. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/thymic.pdf."},{"key":"ref_47","unstructured":"(2023, April 02). Clinical Trials Home Page, Available online: https:\/\/clinicaltrials.gov."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/5\/1170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:33:24Z","timestamp":1760124804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/5\/1170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,12]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["life13051170"],"URL":"https:\/\/doi.org\/10.3390\/life13051170","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,12]]}}}