The combination of lenvatinib and pembrolizumab has demonstrated encouraging results in patients with advanced B3 thymoma and thymic carcinoma who have previously undergone first-line treatment. The findings, presented at the ESMO congress by Dr. Jordi Remon from Gustave Roussy, offer new hope for treating these rare and often late-diagnosed cancers.
PECATI Trial Details
The international phase 2 PECATI trial, conducted across France, Spain, and Italy, enrolled 43 patients with advanced B3 thymoma or thymic carcinoma between September 2021 and February 2024. The average age of participants was 57 years. Patients received 20 mg of oral lenvatinib daily in combination with 200 mg of pembrolizumab via intravenous infusion every three weeks, continuing until disease progression, unacceptable toxicity, or a maximum of two years.
The primary endpoint of the trial was progression-free survival. Initial results indicated that over 80% of patients experienced no disease progression after five months of treatment. At the 12-month mark, more than 50% of patients still showed no disease progression.
Clinical Significance
"These results are positive when compared to disease progression in historical series for patients no longer receiving treatment," noted Dr. Remon. He suggested that lenvatinib combined with pembrolizumab could become a standard treatment for advanced and previously treated type B3 thymoma and thymic carcinoma.
Thymic cancers are rare, with approximately 150 cases diagnosed annually in France, equating to about one or two cases per million inhabitants. Diagnosis often occurs at a metastatic stage, making chemotherapy the primary treatment strategy. The rarity of these cancers limits the development of new treatment options.
Current Treatment Landscape
Standard treatment for advanced or metastatic B3 thymoma and thymic carcinoma typically involves chemotherapy, particularly platinum-based combinations. However, upon disease resistance, there is no established second-line treatment. Recent trials have indicated some activity of lenvatinib (a tyrosine kinase receptor inhibitor) and pembrolizumab (an immunotherapy drug) as monotherapies, prompting the investigation into their combination.
Safety and Tolerability
While the treatment combination was generally well-tolerated, 34% of patients experienced side effects such as diarrhea, hypertension, and liver damage. No treatment-related deaths were reported, but close monitoring is recommended to manage potential toxicities.
The RYTHMIC network in France, dedicated to thymus gland tumors, ensures a multidisciplinary approach to patient management and facilitates clinical trials. This network meets bi-weekly to discuss patient cases and standardize treatment guidelines.
