Thymic Carcinoma

These findings delineate a distinct systemic immune signature in TETs, characterized by IL-18 upregulation and altered ILC1 dynamics, with potential implications for immune regulation and autoimmunity. Circulating ILC profiling combined with IL-18 measurement may represent a promising approach for patient stratification, disease monitoring, and the development of novel immunomodulatory strategies in TETs.

Specifically, stromal CD20+ TIIC density was independently associated with prolonged DFS(HR=4.74, 95% CI(1.673-13.434), P=0.003) and OS (HR=5.086, 95% CI(1.391-18.594), P=0.014), whereas elevated CD204+ TIIC infiltration correlated with reduced DFS(HR=0.154, 95% CI(0.043-0.547), P=0.004) and OS(HR=0.169, 95% CI(0.056-0.607), P=0.002). These findings suggest that targeting M2 macrophage-driven immunosuppression may enhance therapeutic efficacy in TETs.

Carfilzomib synergized with BCL2 family protein inhibitors (navitoclax or AZD5991), suggesting that drug combinations could be used to reduce the dose of each drug to minimize toxicity. Notably, thymic carcinomas differed from squamous cell carcinomas in other organs by higher levels of β5i (PSMB8) and constitutive proteasome β5 (PSMB5). We hypothesize that TC (and probably many TH) are uniquely suited for treatment with proteasome inhibitors alone or in combination with selective BH3 mimetics.

P2, N=20, Recruiting, The First Affiliated Hospital with Nanjing Medical University | Not yet recruiting --> Recruiting

We present a surgical case of an extremely rare asynchronous, isolated thymic metastasis that occurred over 10 years after initial breast cancer surgery. This case underscores the importance of considering thymic metastasis in the differential diagnosis of anterior mediastinal tumors in patients with a remote history of breast cancer.

The discontinuation of lenvatinib in patients with thymic carcinoma caused disease flare in 8% of cases, with KMT2C and KIT mutations emerging as potential contributing factors. These findings suggest that molecular profiling helps in identifying patients at high risk of disease flare and informs future treatment sequencing strategies.

In vitro, TGF-β1 stimulation upregulated PD-L1 expression in a dose-dependent manner, accompanied by increased pSmad2/3 activation. These findings indicate that high TGF-β1 expression demarcates a biologically aggressive TET phenotype and, together with PD-L1, refines postoperative risk stratification, while its ability to drive PD-L1 via Smad signaling could support the blockade of these pathways as a potential therapeutic strategy.

P4, N=40, Not yet recruiting, Nanjing Drum Tower hospital; Nanjing Drum Tower hospital

Emerging therapeutic targets-such as CD70, TIM-3, and B7-H4-are also considered in the context of their potential clinical relevance. Finally, we discuss future directions aimed at improving efficacy, extending response durability, and reducing treatment-related toxicity through biomarker-based patient selection and tailored therapeutic strategies.

This review presents this perspective through discussion of various TET cases, focusing on type A thymoma, type B3 thymoma, and thymic SCC. Rather than asserting a definitive viewpoint, we aim to encourage constructive discussion toward a diagnostic consensus for TETs.

Thymomas had a higher prevalence of T cells compared to TC. CD4+ T cells, CD8+ T cells, and CD68+ cells in the tumor area were favorable prognostic markers, while B cells in the stromal area indicated a poor prognosis for thymoma.

Multimodal regimens with chemoradiotherapy backbone may achieve durable remission for unresectable ITTC, providing an alternative when surgery is contraindicated.