Palliative Systemic Therapy in Advanced Thymic Epithelial Tumors in 2026—A Narrative Review

Palliative systemic therapy for advanced thymic epithelial tumors (TET) is challenging due to scarce evidence and biological heterogeneity. Scientific discussion, as in this review, is limited to cross-trial comparisons of small, non-randomized studies. Platinum-based combination chemotherapy is the standard first-line treatment. Here, we challenge the addition of anthracyclines to platinum in thymoma. We critically appraise new combinations with antiangiogenic drugs and immune checkpoint inhibitors (ICI) in thymic carcinoma and their implications for therapy sequences. We review the data on classic genomics-based targeted therapy that does not benefit most patients and explore established and upcoming biomarkers including KIT and HER2. Finally, we discuss investigational therapies like anti-TROP2 antibody–drug conjugates and proteasome inhibitors, as well as topics and design of future research.