Dr. Remon:
Thank you for this question. Today, the results of the MARBLE trial were presented with the combination of atezolizumab, carboplatin and paclitaxel. This was a positive clinical trial in the first-line setting in patients with advanced thymic carcinoma, reporting an objective response rate of 56%, and a median progression-free survival of 9.6 months. I think it is a relevant result, however, the major issue to-date is how to find the patients who should receive this combination upfront compared to those patients who should start with carboplatin and paclitaxel chemotherapy, and then, in a sequential approach, receive immunotherapy plus antiangiogenics. It is an important clinical trial, but I think we should find the population that will most benefit from this first-line combination, and keep attention about the potential risk of toxicity. In the MARBLE trial the rate of grade 3 immune related adverse events was 67%.
The second trial was about the efficacy and safety of lucitanib in advanced and pre-treated thymic carcinoma. The trial was positive, because compared to best supportive care, lucitanib improved progression-free survival, reducing the risk of progression by 40%. However, today, in this scenario, we have other antiangiogenic agents such as sunitinib and lenvatinib. These agents have reported clinically meaningful results, with higher response rates and longer progression-free survival than lucitanib in this setting. It is relevant that the activity of lucitanib is there, but it seems modest compared to other potential drugs that are already available.
