全身治疗原则（THYM-C）

一线联合化疗方案 [a]

胸腺瘤

首选方案

•CAP（环磷酰胺/多柔比星/顺铂） [1]

其他推荐方案

•卡铂/紫杉醇 [2] , [3] ,

•CAP（环磷酰胺/多柔比星/顺铂）/泼尼松 [4]

•ADOC（多柔比星/顺铂/长春新碱/环磷酰胺） [5]

•PE（顺铂/依托泊苷） [6] ,

•顺铂/依托泊苷/异环磷酰胺 [7]

胸腺癌

首选方案

•卡铂/紫杉醇 [2] , [3] ,

•卡铂/紫杉醇+雷莫芦单抗 [8] , [c]

其他推荐方案

•CAP（环磷酰胺/多柔比星/顺铂） [1]

•CAP（环磷酰胺/多柔比星/顺铂）/泼尼松 [4]

•ADOC（多柔比星/顺铂/长春新碱/环磷酰胺） [5]

•PE（顺铂/依托泊苷） [6] ,

•顺铂/依托泊苷/异环磷酰胺 [7]

•卡铂/紫杉醇+阿替利珠单抗 [9] , [d] , [e] , [f]

后线全身治疗方案

（方案按字母顺序排列）

胸腺瘤

首选方案

•依维莫司 [10]

•吉西他滨/卡培他滨 [g] , [h] , [11] , [12]

•奥曲肽 （包括LAR）（如果奥曲肽扫描或Dotatate PET/CT阳性） [13]

•奥曲肽 （包括LAR）/泼尼松（如果奥曲肽扫描或Dotatate PET/CT阳性） [13] , [14]

•培美曲塞 [15]

其他推荐方案

•氟尿嘧啶 [g] /亚叶酸 [16]

•紫杉醇 [17]

特定情况有用的方案

•依托泊苷 [6] , [18]

•异环磷酰胺 [19]

胸腺癌

首选方案

•吉西他滨/卡培他滨 [g] , [h] , [11] , [12]

•乐伐替尼 [j] , [20]

•帕博利珠单抗 [d] , [e] , [k] , [21] , [22]

•舒尼替尼 [23]

其他推荐方案

•阿昔替尼+阿维鲁单抗 [d] , [e] , [24]

•依维莫司 [10]

•氟尿嘧啶 [g] /亚叶酸 [16]

•紫杉醇 [17]

·培美曲塞 [15]

特定情况有用的方案

•依托泊苷 [6] , [18]

•异环磷酰胺 [19]

a If patients cannot tolerate first-line combination regimens, consider subsequent systemic therapy options.
b Regimens can be used with RT, as definitive concurrent chemoradiation.
c There is no published experience using this as a preoperative therapy. Patients with untreated brain metastases or major standard contraindications to antiangiogenics
were excluded from the study.
d PD-1/PD-L1 inhibitor therapy is not recommended for patients with thymoma. In patients with thymic carcinoma, there is concern for a higher rate of immune-related
adverse events (eg, myocarditis) than seen in most other malignancies treated with PD-1/PD-L1 inhibitor therapy. See NCCN Guidelines for the Management of
Immunotherapy-Related Toxicities.
e PD-1/PD-L1 inhibitor therapy is not recommended in the neoadjuvant setting.
f Atezolizumab and hyaluronidase-tqjs subcutaneous injection may be substituted for IV atezolizumab. Atezolizumab and hyaluronidase-tqjs has different dosing and
administration instructions compared to IV atezolizumab.


d PD-1/PD-L1 inhibitor therapy is not recommended for patients with thymoma. In patients with thymic carcinoma, there is concern for a higher rate of immune-related
adverse events (eg, myocarditis) than seen in most other malignancies treated with PD-1/PD-L1 inhibitor therapy. See NCCN Guidelines for the Management of
Immunotherapy-Related Toxicities.
e PD-1/PD-L1 inhibitor therapy is not recommended in the neoadjuvant setting.
g For information regarding DPYD testing, see NCCN Guidelines for Colon Cancer.
h Gemcitabine or Capecitabine may be given as single agents.
i Nuclear medicine scan (octreotide scan or dotatate PET/CT [dotatate PET/CT preferred if available]) to assess for octreotide-avid disease.
j There is a high risk for side effects and frequent dose reductions may be needed.
k Pembrolizumab and berahyaluronidase alfa-pmph subcutaneous injection may be substituted for IV pembrolizumab. Pembrolizumab and berahyaluronidase alfa-pmph
has different dosing and administration instructions compared to IV pembrolizumab.
         

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NCCN胸腺瘤和胸腺癌指南导航