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The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report
BACKGROUND: Thymomas are characterized by a low tumor mutation burden and a paucity of actionable mutations. Clinical behavior can vary from relatively indolent to very aggressive and impact survival. Platinum-based chemotherapy is the primary treatment modality for inoperable disease and is palliat...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792822/ https://www.ncbi.nlm.nih.gov/pubmed/36582974 http://dx.doi.org/10.21037/med-22-9 |
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author | Sigurdson, Samantha Marom, Edith M. Rimner, Andreas Shepherd, Annemarie Szolkowska, Malgorzata Roden, Anja C. Marino, Mirella Tomiyama, Noriyuki Ball, David Falkson, Conrad Rajan, Arun |
author_facet | Sigurdson, Samantha Marom, Edith M. Rimner, Andreas Shepherd, Annemarie Szolkowska, Malgorzata Roden, Anja C. Marino, Mirella Tomiyama, Noriyuki Ball, David Falkson, Conrad Rajan, Arun |
author_sort | Sigurdson, Samantha |
collection | PubMed |
description | BACKGROUND: Thymomas are characterized by a low tumor mutation burden and a paucity of actionable mutations. Clinical behavior can vary from relatively indolent to very aggressive and impact survival. Platinum-based chemotherapy is the primary treatment modality for inoperable disease and is palliative in intent. Patients with advanced thymoma frequently experience disease recurrence after frontline therapy. Treatment options for relapsed thymoma are relatively limited. A case of recurrent thymoma harboring a breast cancer gene 2 (BRCA2) mutation was presented for multidisciplinary discussion at the International Thymic Malignancy Interest Group (ITMIG) Tumor Board meeting. CASE DESCRIPTION: A 63-year-old female presented with Tumor Node Metastasis (TNM) stage I, World Health Organization (WHO) subtype B1 thymoma at diagnosis and underwent surgical resection. First recurrence occurred in the left costophrenic recess and was treated with preoperative external beam radiotherapy (EBRT), surgical excision, and post-operative chemotherapy. Histology was consistent with WHO subtype B2 thymoma and genomic analysis of the resected tumor detected a BRCA2 mutation. Second recurrence occurred in the mediastinum and bilateral pleurae. Mediastinal disease was treated with EBRT, and the pleural deposits were observed initially. However, upon further progression, the case was discussed at the ITMIG tumor board meeting to determine optimal second line therapy for this patient. CONCLUSIONS: A potential role of poly (ADP-ribose) polymerase (PARP) inhibitors versus cytotoxic chemotherapy for treatment of BRCA2-mutated recurrent thymoma merits discussion. However, due to the absence of data to support the functional and therapeutic significance of BRCA2 mutations in patients with thymoma, the potential for severe toxicity associated with PARP inhibitors, and availability of other safe and effective alternatives, other treatment options should be considered. PARP inhibitors can be considered for treatment of BRCA2-mutated thymomas as part of a clinical trial or when other treatment options have been exhausted. |
format | Online Article Text |
id | pubmed-9792822 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-97928222022-12-28 The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report Sigurdson, Samantha Marom, Edith M. Rimner, Andreas Shepherd, Annemarie Szolkowska, Malgorzata Roden, Anja C. Marino, Mirella Tomiyama, Noriyuki Ball, David Falkson, Conrad Rajan, Arun Mediastinum Case Report BACKGROUND: Thymomas are characterized by a low tumor mutation burden and a paucity of actionable mutations. Clinical behavior can vary from relatively indolent to very aggressive and impact survival. Platinum-based chemotherapy is the primary treatment modality for inoperable disease and is palliative in intent. Patients with advanced thymoma frequently experience disease recurrence after frontline therapy. Treatment options for relapsed thymoma are relatively limited. A case of recurrent thymoma harboring a breast cancer gene 2 (BRCA2) mutation was presented for multidisciplinary discussion at the International Thymic Malignancy Interest Group (ITMIG) Tumor Board meeting. CASE DESCRIPTION: A 63-year-old female presented with Tumor Node Metastasis (TNM) stage I, World Health Organization (WHO) subtype B1 thymoma at diagnosis and underwent surgical resection. First recurrence occurred in the left costophrenic recess and was treated with preoperative external beam radiotherapy (EBRT), surgical excision, and post-operative chemotherapy. Histology was consistent with WHO subtype B2 thymoma and genomic analysis of the resected tumor detected a BRCA2 mutation. Second recurrence occurred in the mediastinum and bilateral pleurae. Mediastinal disease was treated with EBRT, and the pleural deposits were observed initially. However, upon further progression, the case was discussed at the ITMIG tumor board meeting to determine optimal second line therapy for this patient. CONCLUSIONS: A potential role of poly (ADP-ribose) polymerase (PARP) inhibitors versus cytotoxic chemotherapy for treatment of BRCA2-mutated recurrent thymoma merits discussion. However, due to the absence of data to support the functional and therapeutic significance of BRCA2 mutations in patients with thymoma, the potential for severe toxicity associated with PARP inhibitors, and availability of other safe and effective alternatives, other treatment options should be considered. PARP inhibitors can be considered for treatment of BRCA2-mutated thymomas as part of a clinical trial or when other treatment options have been exhausted. AME Publishing Company 2022-12-25 /pmc/articles/PMC9792822/ /pubmed/36582974 http://dx.doi.org/10.21037/med-22-9 Text en 2022 Mediastinum. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Case Report Sigurdson, Samantha Marom, Edith M. Rimner, Andreas Shepherd, Annemarie Szolkowska, Malgorzata Roden, Anja C. Marino, Mirella Tomiyama, Noriyuki Ball, David Falkson, Conrad Rajan, Arun The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title | The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title_full | The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title_fullStr | The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title_full_unstemmed | The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title_short | The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report |
title_sort | therapeutic relevance of a brca2 mutation in a patient with recurrent thymoma: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792822/ https://www.ncbi.nlm.nih.gov/pubmed/36582974 http://dx.doi.org/10.21037/med-22-9 |
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