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Advancements in Treatment of Anaplastic Thyroid Carcinoma Improve OS

A single institution cohort study of patients with anaplastic thyroid carcinoma (ATC) spanning from 2000 to 2019 found a significant increase in OS over the years, suggesting that the once untreatable ATC is being replaced by molecular-based personalized therapies in combination with the integration of multidisciplinary therapies including surgery and radiation therapy (JAMA Oncol. 2020;6[9]:1397-1404). 

The study was conducted by Anastasios Maniakas, MD, MSc, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, and colleagues, to discover if emerging use of targeted therapy, immunotherapy, surgery, and radiation therapy improved overall survival (OS) in patients with ATC.

“[ATC] historically has a 4-month median [OS] from time of diagnosis, with disease-specific mortality approaching 100%. The association between recent major advancements in treatment and OS has yet to be evaluated,” explained Dr Maniakas et al.

A total of 479 (median age, 65.0 years) patients with histopathological confirmation of ATC from January 2000 to October 2019 were included in the study, patients were divided into 3 groups by date: 2000-2013, 2014-2016, and 2017-2019.

At presentation, 52 (11%) of patients were stage IVA, 172 (36%) were stage IVB, and 255 (53%) were stage IVC. The median OS for the entire cohort was 9.5 months. In the 2000-2013 group (n = 227), the OS was 35%  (95% CI, 29%-42%) at 1 year, and 18%  (95% CI, 13%-23%) at 2 years. The 1 and 2 year OS in the 2014-2016 group (n = 100) was 47% (95% CI, 36%-56%) and 25% (95% CI, 17%-34%), respectively. While the OS in the 2017-2019 group (n=152) was 59% (95% CI, 49%-67%) at 1 year, and 42% (95% CI, 30%-53%) at 2 years.

The hazard ratio of the 2017-2019 group compared to the 2000-2013 patients was 0.50 (95% CI, 0.38-0.67, P <.001). Targeted therapy was associated with improved OS  (hazard ratio, 0.49; 95% CI, 0.39-0.63; P < .001), as well as the addition of immunotherapy to targeted therapy (hazard ratio, 0.58; 95% CI, 0.36-0.94; P = .03), and surgery following neoadjuvant BRAF-directed therapy (hazard ratio, 0.29; 95% CI, 0.10-0.78; P = .02).  Furthermore, patients who underwent surgery following neoadjuvant BRAF-directed therapy (n = 20) had a 1-year survival of 94% with a median follow-up of 1.21 years.

“Changes in patient management appear to be associated with significant increase in survival. The era of untreatable ATC is progressively being replaced by molecular-based personalized therapies, with integration of multidisciplinary therapies including surgery and radiation therapy,” concluded Dr Maniakas and colleagues.—Alexandra Graziano

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