title: Pemetrexed in patients with thymic malignancies previously treated with chemotherapy.
abstract: OBJECTIVE
  Thymic malignancies are rare, with limited published trials of chemotherapy activity. We performed a retrospective analysis of pemetrexed activity in patients with thymic malignancies.
  
  
  METHODS
  Patients with unresectable histologically confirmed invasive, recurrent, or metastatic thymoma or thymic carcinoma seen at the Stanford Cancer Center between January 2005 and November 2013 were identified, and those who were treated with pemetrexed in the second-line setting and beyond were included in this analysis.
  
  
  RESULTS
  A total of 81 thymic malignancy patients were identified, of whom 16 received pemetrexed alone (N=14) or in combination (N=2). There were 10 patients (62.5%) with thymic carcinoma and 6 patients (37.5%) with thymoma. Among the 6 patients with thymoma, best response was 1 (17%) with a partial response (PR) and 5 (83%) with stable disease (SD). At a median follow-up of 21.2 months, the median PFS in the thymoma patients was 13.8 months (95% CI, 4.9-22.6 months) and the median OS was 20.1 months (95% CI, 16.4-23.9 months). Among the 10 patients with thymic carcinoma, best response to treatment was 1 (10%) PR, 5 (50%) SD, and 4 (40%) progressive disease (PD). At a median follow-up of 13.5 months, the median PFS in patients with thymic carcinoma was 6.5 months (95% CI, 0.2-12.8 months) and the median OS was 12.7 months (95% CI, 2.9-22.5 months).
  
  
  CONCLUSIONS
  This small retrospective study demonstrates modest pemetrexed activity and disease stabilization in thymic malignancies with a clinically meaningful duration, and supports previous reports of pemetrexed efficacy in these rare diseases.
authors.affiliation: Department of Medical Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Sukhmani K
authors.initials: SK
authors.lastname: Padda
authors.affiliation: Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Riess
authors.affiliation: Division of Hematology/Oncology, University of California Davis Cancer Center, Sacramento, CA, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: West
authors.affiliation: Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Neal
authors.affiliation: Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: hwakelee@stanford.edu.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Wakelee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005971:Glutamates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D000068437:Pemetrexed; D019233:Retreatment; D013953:Thymus Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine
keywords: Chemotherapy; Pemetrexed; Second-line or beyond chemotherapy; Thymic carcinoma; Thymic malignancy; Thymoma