Platinum-Based Chemotherapy with Novel Systemic Therapies in Patients with Unserectable or Metastatic Thymic Epithelial Tumors: A Systematic Review and Single-Arm Meta-Analysis

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All articles of this category (opens in new window) Address for correspondence Gabriela Barbosa Silva (gabrielabarbosa20161@hotmail.com) Introduction: Thymic epithelial tumors (TETs) are rare malignancies with poor prognosis and limited evidence guiding systemic treatment in advanced stages. Following progression on platinum-based chemotherapy, no standard second-line treatment has been established. In recent years, immune checkpoint inhibitors (ICIs) and anti-angiogenic agents have been investigated in combination with chemotherapy to enhance therapeutic efficacy. However, the benefit of these combinations remains unclear. Objective: To evaluate the efficacy of platinum-based chemotherapy combined with novel systemic therapies as a first-line treatment for advanced TETs . Methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted for studies involving histologically confirmed thymoma or thymic carcinoma with unresectable, locally advanced, recurrent, or metastatic disease, treated in the first-line setting with platinum-based doublets plus ICIs or anti-angiogenic agents. Studies on early-stage, resectable tumors, monotherapy regimens, or prior systemic therapy were excluded. Meta-analyses were performed using a random-effects model. Heterogeneity was assessed with the I² statistic and Cochran’s Q test. Sensitivity and subgroup analyses were conducted using meta-analyses of proportions. Results: Of 762 records screened, five phase II trials and four cohort studies met the inclusion criteria, comprising 206 patients (93.7% thymic carcinoma, 6.3% thymoma). Pooled analysis showed a median duration of response of 12.32 months (95% CI: 5.43–27.93), a median progression-free survival of 13.69 months (95% CI: 8.45–22.19), and an objective response rate (ORR) of 58.9% (95% CI: 45.7–71.0). ORR was higher with anti-angiogenic agents 68.5% (95% CI: 52.5–81.0) than with ICIs 52.0%, (95% CI: 35.9–67.6; p = 0.1472). A statistically significant difference in partial response rates was observed between anti-angiogenic agents 68.5% and ICIs 46.9% (p = 0.0898). Conclusion: Despite the lack of randomized evidence, platinum-based chemotherapy combined with anti-angiogenic agents may represent a promising first-line strategy for patients with advanced TETs, particularly those with thymic carcinoma. Prospective evaluation is warranted to validate these results. Publication History Article published online: 26 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil Bibliographical Record Gabriela Barbosa Silva, Lorrany Rodrigues Costa, Bianca Gonzaga Freitas, Letícia Peixoto Gomes, Filipe Luís Vasconcelos Visani. Platinum-Based Chemotherapy with Novel Systemic Therapies in Patients with Unserectable or Metastatic Thymic Epithelial Tumors: A Systematic Review and Single-Arm Meta-Analysis. Brazilian Journal of Oncology 2026; 22. DOI: 10.1055/s-0046-1825474