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She achieved 23 months of stabilization before sudden death. Postmortem imaging suggested acute exacerbation of interstitial pneumonia, highlighting prolonged control potential and the need for careful pulmonary 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Sekine1 and Tadao Nakazawa2  \nRare Tumors Volume 18: 1–4 © The Author(s) 2026 Article reuse guidelines:  \n[sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/20363613251414563](DOI: 10.1177/20363613251414563)  \n[journals.sagepub.com/home/rtu](journals.sagepub.com/home/rtu)  \nAbstract  \nLenvatinib, a multi-kinase inhibitor, has shown promising activity in unresectable thymic carcinoma, but long-term realworld data are scarce. We describe a 72-year-old woman with Masaoka stage IVb thymic squamous cell carcinoma who experienced disease progression after ADOC chemotherapy and multiple courses of thoracic radiotherapy. Lenvatinib was initiated at 24 mg/day and reduced to 8 mg/day because of hypertension, hemoptysis, and hypothyroidism. The patient achieved 23 months of disease stabilization before sudden death at home. Postmortem imaging suggested acute exacerbation of interstitial pneumonia. This case highlights the potential of lenvatinib to achieve prolonged disease control even at reduced doses and underscores the need for careful pulmonary monitoring in patients with prior thoracic irradiation.  \nKeywords  \nthymic carcinoma, lenvatinib, interstitial pneumonia, radiotherapy-induced toxicity, rare cancer  \nReceived: 14 July 2025; accepted: 18 December 2025  \nIntroduction  \nThymic carcinoma is a rare and aggressive malignancy arising from thymic epithelial cells, accounting for less than 1% of all mediastinal tumors. Optimal treatment strategies for advanced or recurrent disease remain poorly defined. Platinum-based chemotherapy regimens such as ADOC (cisplatin, doxorubicin, vincristine, and cyclophosphamide) are commonly used first-line; however, disease progression is frequent and effective second-line therapies are limited.1–5 Lenvatinib, a multi-tyrosine kinase inhibitor targeting  \nVEGFR, FGFR, PDGFR, and RET, demonstrated a disease control rate of 95% in a phase II trial in Japan, leading to its approval in 2021 for advanced or unresectable thymic carcinoma. Nevertheless, data on long-term real-world efficacy and safety, especially in patients with prior thoracic radiotherapy, remain scarce.  \nHere we report a case of advanced thymic squamous cell carcinoma treated with lenvatinib following chemotherapy failure and repeated thoracic radiotherapy. The patient achieved disease stabilization for 23 months despite dose reduction, and ultimately died of presumed acute  \nexacerbation of interstitial pneumonia. This case illustrates both the therapeutic potential and the pulmonary risks of lenvatinib in heavily pretreated patients.  \nCase presentation  \nA 72-year-old Japanese woman with no smoking history was incidentally found to have an anterior mediastinal mass and multiple pulmonary nodules on routine chest computed tomography (CT) . Contrast-enhanced CT revealed a 60 × 30 mm anterior mediastinal mass  \n1 Department of Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan  \n2Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan  \nCorresponding author:  \nEitetsu Koh, Department of Thoracic Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo City, Chiba 276-8524, Japan.  \nEmail: eitetsuk@gmai[l.com](l.com)  \nCreative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons  \nAttribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use,  \nreproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ([https://us.sagepub.com/en-us/nam/open-access-at-sage](https://us.sagepub.com/en-us/nam/open","cbCaie01xI3CFsn5","https://ap.wps.com/l/cbCaie01xI3CFsn5","pdf",766902,"English","# Abstract\n# Keywords\n# Introduction\n# Case presentation\n## Initial diagnosis and staging\n## Prior treatments and disease progression\n## Lenvatinib treatment and dose adjustments\n## Disease course and outcome","[{\"question\":\"Why was lenvatinib dose reduced in this case?\",\"answer\":\"Dose reduction from 24 mg/day to 8 mg/day was implemented due to hypertension, hemoptysis, and hypothyroidism that occurred within two weeks of starting lenvatinib.\"},{\"question\":\"How long did the patient’s disease remain stable after starting lenvatinib?\",\"answer\":\"The patient achieved disease stabilization for 23 months, including stable disease on serial CT scans over an 18-month period before later progression.\"},{\"question\":\"What was the suspected cause of death?\",\"answer\":\"The article reports sudden death at home, and postmortem imaging suggested acute exacerbation of interstitial pneumonia.\"}]","Long-term disease stabilization with lenvatinib in advanced thymic carcinoma - A case report | PDF",1790718835]