Anaplastic Thyroid Carcinoma: An Update

Abstract

Anaplastic thyroid carcinoma (ATC) is a rare and undifferentiated form of thyroid cancer. Its prognosis is poor: the median overall survival (OS) of patients varies from 4 to 10 months after diagnosis. However, a doubling of the OS time may be possible owing to a more systematic use of molecular tests for targeted therapies and integration of fast-track dedicated care pathways for these patients in tertiary centers. The diagnostic confirmation, if needed, requires an urgent biopsy reread by an expert pathologist with additional immunohistochemical and molecular analyses. Therapeutic management, defined in multidisciplinary meetings, respecting the patient’s choice, must start within days following diagnosis. For localized disease diagnosed after primary surgical treatment, adjuvant chemo-radiotherapy is recommended. In the event of locally advanced or metastatic disease, the prognosis is very poor. Treatment should then involve chemotherapy or targeted therapy and decompressive cervical radiotherapy. Here we will review current knowledge on ATC and provide perspectives to improve the management of this deadly disease.

Strategies for Radioiodine Treatment: What’s New

“…Moreover, BRAF mutated tumors have a less-differentiated phenotype with the downregulation of iodine metabolism genes, such as NIS and thyroperoxidase (TPO) [ 183 , 184 ] resulting in a decreased or absent radioiodine uptake and the loss of RAI sensitivity [ 92 ]. TERT promoter mutations are considered to be a late event in DTC carcinogenesis and are often found in more aggressive histological types, such as PDTC [ 185 ] and anaplastic thyroid cancer [ 186 ]. The BRAF and TERT duet is associated with a poor outcome [ 182 , 187 ].…”

Rationale Efficacy and Safety Evidence of Lenvatinib and Pembrolizumab Association in Anaplastic Thyroid Carcinoma

“…Elevated TAM levels in ATC tumor samples cause a hot immunological environment in 34% of cases, which is characterized by high expression of various inhibitory immune checkpoint mediators, including programmed death-ligand 1 (PD-L1) [ 4 , 19 ]. In both a phase-I investigation of the immune checkpoint inhibitor spartalizumab [ 20 ] and a pre-clinical study [ 21 ], 70% of ATC samples had PD-L1 expression.…”

“…In the revised 8th edition of the TNM classification, all ATC patients are classified as stage IV and patients with distant metastasis are classified as stage IV C [ 3 ]. For the non-metastatic disease, current first-line treatment recommendations are based on surgery radiotherapy and targeted therapies, depending on the presence of the BRAF V600E mutation [ 4 ]. Despite this multimodal approach, the prognosis in patients with ATC is poor, with a median overall survival (OS) of 9.5 months [ 5 ].…”

Das Schilddrüsenkarzinom – Diagnostik, Therapie und klinische Bedeutung

“…Deshalb muss vor der Planung einer Resektion, auch im Sinne eines Tumordebulkings, immer Radikalität gegen mögliche Komplikationen abgewogen werden. Ist jedoch eine lokale Tumorresektion im Sinne einer R0/R1-Situation möglich, kann die Prognose der Patient*innen mithilfe multimodaler Therapien verbessert werden 14 , 15 .…”