title: The efficacy of tacrolimus and sirolimus in heavily pre-treated unresectable thymic malignancies.
abstract: BACKGROUND
  Thymomas and thymic carcinomas, although uncommon, constitute a significant proportion of anterior mediastinal tumours. Systemic chemotherapy is the mainstay of treatment for inoperable or recurrent disease, but immunosuppressive therapy may provide an alternative treatment strategy.
  
  
  METHODS
  We present a series of 18 patients diagnosed with unresectable thymic tumours, of which eight received immunosuppressive therapy following relapse after chemotherapy.
  
  
  RESULTS
  Eight individuals were treated with primary immunotherapy after a median of 3.5 lines of chemotherapy (range 2-6 lines), of which 3 had confirmed myasthenia gravis (MG). After 3 months, 2 patients achieved a radiological partial response and 4 had stable disease. The median time to progression measured 6.8 months (CI 1.4-19.3 months). Two of the 4 patients who progressed on tacrolimus and prednisolone received sirolimus. One of these patients has stable disease (SD) at 21 months, and the other has SD at 3 months.
  
  
  CONCLUSIONS
  Although previous case reports have related tacrolimus therapy with tumour shrinkage in patients with MG-associated invasive thymomas, these data are the first to demonstrate the efficacy of such immunosuppressive agents in a larger cohort of heavily pre-treated patients with thymic tumours. Our experience adds to the limited anecdotal evidence in the literature, and suggests that immunosuppressive agents represent a valuable additional treatment for thymic tumours.
authors: Barts Cancer centre, St. Bartholomew's Hospital, 7th Floor Gloucester House, West Smithfield, London, UK. .
authors: S J L
authors: SJ
authors: Payne
authors: J
authors: J
authors: Krell
authors: P
authors: P
authors: Wilson
authors: W
authors: W
authors: Ansell
authors: A E
authors: AE
authors: Frampton
authors: J
authors: J
authors: Stebbing
authors: J
authors: J
authors: Shamash
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D064420:Drug-Related Side Effects and Adverse Reactions / Q000139:chemically induced / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013934:Thymectomy; D013953:Thymus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus