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Treatment of Invasive Thymoma With Single-Agent Ifosfamide

From the Departments of Oncology and Surgery, Guy's Hospital, and the Brook Hospital, London; the Royal Devon and Exeter Hospital, Exeter; the Royal Sussex Hospital, Brighton; and Pembury Hospital, Turnbridge Wells, England.

Address reprint requests to M.S. Highley, MD, Department of Cancer Medicine, Ninewells Hospital, Dundee DD1 9SY, United Kingdom.

PURPOSE: To evaluate single-agent ifosfamide in the treatment of invasive thymoma.

PATIENTS AND METHODS: Fifteen patients (eight male and seven female) with histologically confirmed invasive thymoma were treated. The median age was 48 years (range, 23 to 76 years). Four patients had stage III disease, seven patients had stage IVa disease, and four patients had stage IVb disease. The most common histologic type was lymphoepithelial. Seven patients had received prior treatment, including one patient who received chemotherapy. Ifosfamide 1.5 g/m² was given on days 1 to 5, with mesna as a uroprotector.

RESULTS: Thirteen patients were assessable for response. Five complete responses (38.5%; 95% confidence interval [CI], 17.7% to 64.5%) and one partial response (7.7%; 95% CI, 1.4% to 33.3%) were seen. The median duration of complete response was 66+ months (range, 25 to 87 months), and the estimated survival rate 5 years after ifosfamide treatment was 57% (SE, 32% to 79%). The most frequent toxicities were nausea, vomiting, and leucopenia, but these were well tolerated.

CONCLUSION: Single-agent ifosfamide possesses significant activity against invasive thymoma and is comparable to currently used combination regimens. The inclusion of ifosfamide in combination therapy, particularly in place of cyclophosphamide in regimens such as cisplatin, doxorubicin, and cyclophosphamide, needs to be evaluated.

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