Open AccessMultimodal treatments and outcomes for anaplastic thyroid cancer before and after tyrosine kinase inhibitor therapy: a real-world experience
Author(s) -
Jun Park,
Hyun Ae Jung,
Joon Ho Shim,
Woong-Yang Park,
Tae Hyuk Kim,
SeHoon Lee,
Sun Wook Kim,
MyungJu Ahn,
Keunchil Park,
Jae Hoon Chung
Publication year - 2021
Publication title -
european journal of endocrinology
Language(s) - English
Resource type - Journals
eISSN - 1479-683X
pISSN - 0804-4643
DOI - 10.1530/eje-20-1482
Subject(s) - medicine , lenvatinib , dabrafenib , anaplastic thyroid cancer , radiation therapy , oncology , trametinib , tyrosine kinase inhibitor , progression free survival , thyroid cancer , combination therapy , targeted therapy , cancer , surgery , chemotherapy , vemurafenib , kinase , mapk/erk pathway , metastatic melanoma , biology , microbiology and biotechnology
Background Anaplastic thyroid cancer (ATC) has dismal prognosis and there is no effective treatment. We aimed to evaluate the efficacy of tyrosine kinase inhibitor (TKI) therapy in real-world clinic and to suggest the most effective treatment modality according to the combination of treatments. Methods This retrospective study evaluated clinical outcomes and cause of death with multimodal treatments in patients with ATC at Samsung Medical Center. Results A total of 120 patients received anti-cancer treatment for ATC. Seventy-seven (64.2%) patients underwent surgery, 64 (53.3%) received radiotherapy, 29 (24.2%) received cytotoxic chemotherapy, and 19 (15.8%) received TKI therapy. In the TKI therapy group, eight achieved partial response (three with lenvatinib and five with dabrafenib plus trametinib), and two patients with lenvatinib showed stable disease. Median progression-free survival (PFS) of the TKI therapy group was 2.7 months (range: 0.1–12.7) and their median overall survival (OS) was 12.4 months (range: 1.7–47.7). Patients who received surgery or radiotherapy for local control showed superior OS than those who did not. In a multivariate analysis, surgery, TKI therapy, younger age, and no distant metastasis were associated with favorable OS. The combination of surgery, radiotherapy, and TKI therapy (median OS: 34.3 months, 6-month survival rates: 77.8%) was the most effective. Compared to the era without TKI therapy, distant metastasis has recently become the major cause of death in ATC over airway problems. Conclusions Multimodality treatment including TKI therapy demonstrated prolonged survival with dabrafenib plus trametinib as the most effective therapeutic option demonstrated for BRAF mutant ATC patients.