Thymic epithelial tumors are a histologically diverse group of cancers arising from the epithelial compartment of the thymus. These tumors are characterized by a low tumor mutation burden, a lack of actionable genomic changes, and, especially with thymomas, defects in immune tolerance. Surgery is the mainstay of the management of resectable disease, whereas advanced, unresectable tumors are treated with platinum-based chemotherapy. Disease recurrence can occur months to years after frontline treatment. Although several options are available for conventional treatment of recurrent thymic tumors, response rates are generally low, and treatment-related toxicity can affect quality of life. A subset of patients benefit from biologic therapies, but there remains an unmet need for the development of new treatments. Immune checkpoint inhibitors are safe, clinically active, and have contributed to an improvement in survival for patients with a wide variety of cancers. However, the application of these revolutionary treatments for thymic cancers is limited to their use for the management of recurrent thymic carcinoma because of the risk of immune toxicity. In this paper, we review the current uses of immunotherapy for the management of thymic epithelial tumors and highlight potential strategies to improve safety and broaden the application of these treatments for patients with thymic cancers.
胸腺上皮肿瘤是一组组织学上异质性的癌症，起源于胸腺的上皮部分。这类肿瘤的特征包括肿瘤突变负荷低、缺乏可操作的基因组改变，以及（尤其在胸腺瘤中）免疫耐受缺陷。手术是可切除疾病的主要治疗手段，而晚期不可切除肿瘤则采用铂类化疗。疾病复发可能发生在初始治疗后数月到数年。尽管针对复发性胸腺肿瘤有多种常规治疗方案，但总体缓解率较低，且治疗相关毒性可能影响生活质量。部分患者可从生物治疗中获益，但新疗法的开发需求仍未得到满足。免疫检查点抑制剂安全性良好，具有临床活性，并已显著改善多种癌症患者的生存期。然而，由于免疫毒性风险，这类革命性疗法在胸腺癌中的应用仅限于治疗复发性胸腺癌。本文综述了免疫疗法在胸腺上皮肿瘤治疗中的当前应用，并重点探讨了提高安全性及扩大这些疗法在胸腺癌患者中应用范围的潜在策略。
Immunotherapy for Thymomas and Thymic Carcinomas: Current Status and Future Directions
肿瘤(癌症)患者之家