Efficacy and Safety of First-Line Anti-PD-1 Antibody Combined With Taxane-Platinum Versus Taxane-Platinum Alone in Metastatic Thymic Carcinoma: A Real-World Retrospective Study.

Background: Thymic carcinoma (TC) is a rare, aggressive malignancy with limited treatment options. While paclitaxel combined with carboplatin is the standard first-line regimen, its efficacy remains suboptimal. This study assessed the efficacy and safety of adding anti-PD-1 antibodies to taxane-platinum (TP) in a homogeneous cohort.

Methods: In this real-world retrospective study, 107 patients with metastatic TC were divided into the TP plus anti-PD-1 antibody (TP + PD-1) group (n = 47) and the TP group (n = 60). Survival outcomes were analyzed using the Kaplan-Meier method, and the factors affecting survival were evaluated by Cox regression analysis.

Results: The TP + PD-1 group showed significantly prolonged median progression-free survival (PFS, 9.43 vs. 6.3 months; HR = 0.37, 95% CI, 0.25-0.65; P < .001), with comparable overall survival (52.3 vs. 32.8 months; HR = 0.44, 95% CI, 0.17-1.17; P = .080). Objective response rate (44.7% vs. 46.7%, P = .880) and disease control rate (97.9% vs. 90.0%, P = .085) were comparable between groups. Multivariate analysis identified anti-PD-1 antibody (HR = 0.34, P = .004) and ECOG PS (HR = 3.7, P = .009) as independent predictors of PFS. Grade 3-4 treatment-related adverse events (23.4% vs. 31.7%, P = .449) and immune-related adverse events (31.9% grade 1-2) were manageable.

Conclusions: The addition of anti-PD-1 antibodies to TP significantly improved PFS in metastatic TC with manageable toxicity, suggesting that this combination may represent a promising first-line option. Further randomized trials are needed to confirm OS benefits.