Update on current diagnosis and management of anaplastic thyroid carcinoma

Abstract

Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS . Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.

Current status of anaplastic thyroid carcinoma

“…Positron emission tomography is the best option for finding occult tumor deposits. Liquid biopsy can detect malignant cells and it could contribute to diagnosis, prognosis and follow-up[ 1 ].…”

“…Other genes such as BRAF , MET , NTRK have first-line targeted therapies. With regard to the field of immunotherapy, PD-L1 expression is high in the samples analyzed, which may improve the response according to data recently published[ 1 ].…”

“…Anaplastic thyroid cancer (ATC) is a clinical entity with a high mortality and a 5-year survival of less than 0.2%. Pavlidis et al [ 1 ] have performed a review of ATC, emphasizing the importance of early diagnosis and multimodal therapy to achieve the highest survival in this group of patients.…”

Papillary Thyroid Cancer Remodels the Genetic Information Processing Pathways

“…The American Cancer Society estimates that in 2024, the USA will register 44,020 (31,520 women and 12,500 men) new cases of thyroid cancer (TC), out of which 2170 (1180 females + 990 males) might die because of it [1]. The most lethal form is the nondifferentiated (anaplastic) TC, with only 5 months median survival rate [2] and 8% average 5-year Relative Survival Rate (RSR) when all Surveillance, Epidemiology, and End Results (SEER) stages are considered [1]. The least lethal is the differentiated papillary thyroid carcinoma (PTC) that covers over 8 out of 10 thyroid malignancies, grows slowly, and has a favorable (>99%) 5-year survival prognosis [3,4].…”

Papillary Thyroid Cancer Remodels the Genomic Fabrics of DNA Replication, Repair and Transcription

“…The American Cancer Society estimates that in 2024 U.S.A. will register new 44,020 (31,520 women and 12,500 men) cases of thyroid cancer (TC), out of which, and 2,170 (1,180 females + 990 males) might die because of it [1]. The most lethal form is the non-differentiated (anaplastic) TC with 5 months' median survival rate [2]. The least lethal is the differentiated papillary thyroid carcinoma (PTC) that covers over 8 out of 10 thyroid malignancies, growths slowly and has a favorable (> 95%) 5-year survival prognosis [3,4].…”