BAPP                                                 thymoma(137)
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  bleomycin....... 12 U/sqm IV day 1.
  adriamycin...... 50 mg/sqm IV day 1.
  cisplatin....... 50 mg/sqm IV day 1.
  prednisone...... 40 mg/sqm/day orally from day 1 to day 5.
  FREQUENCY....... Repeat cycle every 4 weeks.

                   


  reference...
    Chahinian AP.  Bhardwaj S.  Meyer RJ.  Jaffrey IS. Kirschner 
    PA.  Holland JF. Treatment of invasive or metastatic thymoma: 
    report of eleven cases. Cancer.  47(7):1752-61, 1981 Apr 1. 
  abstract...
    The clinical presentation and therapeutic modalities of 11 
    patients with invasive or metastatic thymoma are presented. 
    Two patients had myasthenia gravis, and five had extrathoracic 
    metastases. Survival exceeded five years in five patients, and 
    four patients remain free of recurrence between 2.1 and 9.0 
    years after diagnosis. Surgery, with an attempt at complete 
    resection, is the first step of therapy. A second thoracotomy 
    for local relapse or attempt at curative resection was carried 
    out in four patients. Radiotherapy to the mediastinum and/or 
    metastatic sites was given to ten patients with doses ranging 
    from 3600-6000 rads (median = 4500 rads) in the nine 
    nonmyasthenic patients. Inclusion of supraclavicular fossae in 
    the radiotherapy field is recommended because it was a site of 
    relapse in two patients. Systemic therapies were given to 
    eight patients. Objective responses were seen with two of 
    various chemotherapeutic regimens. A combination of bleomycin, 
    Adriamycin, cisplatin, and prednisone ("BAPP") produced a 
    partial remission in two of five patients, during 12 and 4 
    months, respectively. Two of three patients responded to 
    maytansine as a single agent after failure of other agents. 
    Immunotherapy with intravenous Corynebacterium parvum or 
    intradermal Methanol-Extraction Residue of bacillus 
    Calmette-Guerin (MER-BCG) was ineffective in one patient each. 
    The importance of combined modalities in the management of the 
    disease is emphasized.