Capecitabine and Celecoxib as a Promising Therapy for Thymic Neoplasms

Abstract

Objectives: For patients with unresectable or metastatic thymic epithelial neoplasms, few therapy options are available and outcomes are poor. This case series demonstrates that the combination of capecitabine and celecoxib may be a promising therapeutic option for these patients.

Materials and methods: The current report describes the outcomes of 5 patients with thymic neoplasms treated on a drug-drug interaction study of capecitabine and celecoxib in patients with advanced solid malignancies (NCT01705106) conducted at the University of Chicago, plus a sixth patient treated with the same regimen outside of the protocol.

Results: Six patients with thymic neoplasms were treated with capecitabine 1000 mg/m twice daily and celecoxib 200 mg twice daily, day 1 to day 14 on a 21-day cycle. This included 3 patients with thymic carcinoma, 1 with thymic neuroendocrine tumor, and 2 with thymomas. Objective response rates were noted in 3 of 6 patients. Two of the 3 thymic carcinoma patients had complete responses, and the third had a partial response. Best response for the other patients included stable disease for both thymoma patients and progressive disease for the thymic neuroendocrine patient. Other than grade 3 palmar-plantar erythrodysesthesia, which developed in 4 of 6 patients and required dose reductions, the regimen was well tolerated.

Conclusions: This case series suggests that capecitabine plus celecoxib may be an effective and well-tolerated treatment option for patients with thymic carcinoma. Further studies should be carried out to establish the efficacy of capecitabine plus celecoxib in thymic carcinoma, and to determine whether monotherapy with capecitabine would be similarly effective.

Conflict of interest statement

There are no conflicts of interest disclosures for any authors.

Figures

Figure 1

Clinical presentation and course of the three thymic carcinoma patients. Patients 1 and 2, in Panels A and B, respectively, both had a CR. Patient #1 had a CR after 14 months and was placed on active surveillance after 18 months of therapy. He remained in CR until month 23, when he developed growing lung lesions with pathology confirming recurrence. He was started on a clinical trial with the drug ilorasertib for CDKN2A deficient tumors. Patient 2 had a CR after 22 months of therapy and was placed on active surveillance after 23 months; he remains in a CR at 33 months. Patient 3, in Panel C, developed a PR as best response (80% reduction in tumor size by RECIST criteria). Patient 3 was placed on a drug holiday after 6 months of therapy. She progressed 4 months later and was restarted on therapy, with best response SD. She developed progression of disease after another 12 months of therapy.

Figure 1

Clinical presentation and course of the three thymic carcinoma patients. Patients 1 and 2, in Panels A and B, respectively, both had a CR. Patient #1 had a CR after 14 months and was placed on active surveillance after 18 months of therapy. He remained in CR until month 23, when he developed growing lung lesions with pathology confirming recurrence. He was started on a clinical trial with the drug ilorasertib for CDKN2A deficient tumors. Patient 2 had a CR after 22 months of therapy and was placed on active surveillance after 23 months; he remains in a CR at 33 months. Patient 3, in Panel C, developed a PR as best response (80% reduction in tumor size by RECIST criteria). Patient 3 was placed on a drug holiday after 6 months of therapy. She progressed 4 months later and was restarted on therapy, with best response SD. She developed progression of disease after another 12 months of therapy.

Figure 1

Clinical presentation and course of the three thymic carcinoma patients. Patients 1 and 2, in Panels A and B, respectively, both had a CR. Patient #1 had a CR after 14 months and was placed on active surveillance after 18 months of therapy. He remained in CR until month 23, when he developed growing lung lesions with pathology confirming recurrence. He was started on a clinical trial with the drug ilorasertib for CDKN2A deficient tumors. Patient 2 had a CR after 22 months of therapy and was placed on active surveillance after 23 months; he remains in a CR at 33 months. Patient 3, in Panel C, developed a PR as best response (80% reduction in tumor size by RECIST criteria). Patient 3 was placed on a drug holiday after 6 months of therapy. She progressed 4 months later and was restarted on therapy, with best response SD. She developed progression of disease after another 12 months of therapy.

Figure 2

Radiographic Response in patient #1. CT scan for patient #1 at baseline (left panel) and after 14 months of capecitabine/celecoxib (right panel). The patient had a complete response, with complete resolution of his pulmonary metastases.