Characteristics and outcomes of thymomas in Latin America: results from over 10 years of experience (CLICaP-LATimus)

Background: Thymomas are a group of rare neoplasms of the anterior mediastinum.The objective of this study was to describe the demographics, clinical characteristicsand treatment approaches in Latin America.Methods: This was a retrospective multicenter cohort study including patients withhistologically proven thymomas diagnosed between 1997 and 2018. Demographics, linicopathological characteristics and therapeutic outcomes were collected locallyand analyzed in a centralized manner.Results: A total of 135 patients were included. Median age at diagnos is was 53 yearsold (19–84), 53.3% (n = 72) of patients were female and 87.4% had an ECOG perfor-mance score ranging from 0–1. A total of 47 patients (34.8%) had metastatic diseaseat diagnosis. Concurrent myasthenia gravis occurred in 21.5% of patients. Surgerywas performed in 74 patients (54.8%), comprising 27 (20%) tumorectomies and47 (34.8%) thymectomies. According to the Masaoka-Koga system, overall survival(OS) at five-years was 73.4%, 63.8% and 51%, at stages I–II, III–IVA and IVB,respectively (p = 0.005). Furthermore, patients with low lactate dehydrogenase(LDH) (≤373 IU/L) at baseline and myasthenia gravis concur rence showed signifi-cantly better OS (p = 0.001 and p = 0.008, respectively). In multivariate analysis, highLDH levels (HR 2.8 [95% confidence interval [CI]: 1.1–7.8]; p = 0.036) at baselineand not performing a surgical resection (HR 4.1 [95% CI: 1.3–12.7]; p = 0.016) weresignificantly associated with increased risk of death.Conclusions: Our data provides the largest insight into the clinical characteristics andoutcomes of patients with thymomas in Latin America. Survival in patients withthymomas continues to be very favorable, especially when subjected to adequatelocal control

Immunotherapy at any line of treatment improves survival in patients with advanced metastatic non‐small cell lung cancer (NSCLC) compared with chemotherapy (Quijote‐CLICaP)

Background: To compare survival outcomes of patients with advanced or metastatic non-small cell lung cancer (NSCLC) who received immunotherapy as first-, second- or beyond line, versus matched patients receiving standard chemotherapy with special characterization of hyperprogressors. Methods: A retrospective cohort study of 296 patients with unresectable/metastatic NSCLC treated with either, first-, second-, third- or fourth-line of immunotherapy was conducted. A matched comparison with a historical cohort of first-line chemotherapy and a random forest tree analysis to characterize hyperprogressors was conducted. Results: Median age was 64 years (range 34–90), 40.2% of patients were female. A total of 91.2% of patients had an Eastern Cooperative Oncology Group (ECOG) performance score ≤ 1. Immunotherapy as first-line was given to 39 patients (13.7%), second-line to 140 (48.8%), and as third-line and beyond to 108 (37.6%). Median overall survival was 12.7 months (95% CI 9.67–14 months) and progression-free survival (PFS) of 4.27 months (95% CI 3.97–5.0). Factors associated with increased survival included treatment with immunotherapy as first-line (P < 0.001), type of response (P < 0.001) and PD-L1 status (P = 0.0039). Compared with the historical cohort, immunotherapy proved to be superior in terms of OS (P = 0.05) but not PFS (P = 0.2). A total of 44 hyperprogressors were documented (19.8%, [95% CI 14.5–25.1%]). Leukocyte count over 5.300 cells/dL was present in both hyperprogressors and long-term responders. Conclusions: Patients who receive immune-checkpoint inhibitors as part of their treatment for NSCLC have better overall survival (OS) compared with matched patients treated with standard chemotherapy, regardless of the line of treatment