Thymomas are the most common tumours of the anterior mediastinum; their clinical course is often complicated by accompanying autoimmune and paraneoplastic syndromes. Advanced malignant thymoma is particularly challenging to manage owing to the lack of evidence from randomised trials to guide treatment. Combination first-line chemotherapy has been trialled in several small studies and has been reported to produce a 50-80% response with platinum-containing regimes. Progression following first-line chemotherapy is difficult to manage as most of these patients maintain a good performance status and demand further active palliative treatment. There is no standard second-line treatment. We report a good clinical and radiological response to third-line palliative octreotide therapy in a patient who had a positive octreotide scan.