BACKGROUND Thymic carcinoma is a rare epithelial neoplasm that tends to be aggressive and metastasize widely. The optimal chemotherapy for unresectable advanced thymic carcinoma has not yet been established because of its rare occurrence. The purpose of this study was to evaluate the efficacy and tolerability of combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds for advanced thymic carcinoma. METHODS A retrospective analysis of 34 patients with untreated and unresectable thymic carcinoma who received chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds between 1996 and 2010 was conducted. Twenty-nine patients were treated with a combination of cisplatin (50 mg/m(2)) and doxorubicin (40 mg/m(2)) on day 1, vincristine (0.6 mg/m(2)) on day 3, and cyclophosphamide (700 mg/m(2)) on day 4. Five patients were treated with carboplatin (area under the curve of 3.0 minutes · mg/ml) instead of cisplatin. RESULTS The responses of all 34 patients to the current regimen were assessed. The median number of treatment cycles for the present chemotherapy was 4. The overall response rate and disease control rate were 50.0% and 88.2%, respectively. The median survival was 21.3 months (95% confidence interval [CI], 15.0-37.2 months), and the 1-year and 3-year survival rates were 72.7% (95% CI, 56.8-88.6%) and 34.4% (95% CI, 16.2-52.6%), respectively. The most common adverse event was leukopenia/neutropenia, and nonhematological toxicities were mild. CONCLUSIONS Combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds is an effective and well-tolerated treatment for unresectable advanced thymic carcinoma.