Survival Benefit With Aggressive Multimodality Therapy in Anaplastic Thyroid Cancer

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Aggressive multimodal therapy increases the overall survival of patients with anaplastic thyroid carcinoma.
Aggressive multimodal therapy increases the overall survival of patients with anaplastic thyroid carcinoma.

Aggressive multimodal therapy increases the overall survival of patients with anaplastic thyroid carcinoma, according to recent data presented at the 15th International Thyroid Congress and 85th Annual Meeting of the American Thyroid Association.

Aditi Kumar, MD, from the division of endocrinology at the Mayo Clinic in Rochester, Minnesota, said that outcomes for anaplastic thyroid carcinoma have historically been poor, with an overall survival rate of approximately 5 months.

“Although historical overall survival in [anaplastic thyroid cancer] has been very poor, aggressive multimodality therapy combining surgery (where feasible), intensity modulated radiation therapy (IMRT), and cytotoxic chemotherapy, in our experience, can result in longer-term survival, especially in lower-stage disease,” Dr Kumar said in an email interview with Endocrinology Advisor.

However, Dr Kumar said the aggressive therapy comes at a cost, which can include frequent provider visits and intensive, toxic therapy, among other issues.

In their pilot study, Dr Kumar and colleagues found median Kaplan-Meier survival rates of 60 months, with a 1-year survival rate of 70% and a 2-year survival rate of 60% in a small series of patients with anaplastic thyroid cancer.

In the expanded study, the results of which were presented at the meeting, the researchers included 29 patients from the Mayo Clinic between 2003 and 2015 with anaplastic thyroid cancer (median age, 60 years; 72% men) at various stages of disease.

Of the patients recruited, 2 patients had stage IVA at diagnosis, 20 patients had stage IVB, and 7 patients were classified as stage IVC.

Ninety-three percent of patients underwent surgery, and the researchers noted no residual tumor resection in 24% of patients and microscopic residual tumor resection in 52% of patients.

The aggressive multimodal therapy included chemotherapy, with 24 patients (83%) receiving taxanes and 19 patients (66%) receiving docetaxel/doxorubicin.

Patients also underwent definitive-intention locoregional radiation (median=66 Gy; range=46-70 Gy; median fractions=33), which was completed by 24 (83%) patients.

Dr Kumar and colleagues reported that 4 patients did not complete radiation therapy due to toxicity, and 1 patient died during radiation therapy.

RELATED: New Guidelines Available For the Management of Thyroid Cancer

At 22.4 months, 10 patients (34%) were currently living, and median Kaplan-Meier overall survival was 22.4 months. One-year Kaplan-Meier overall survival was 61%, 3-year overall survival was 48%, and 5-year overall survival was 43%.

Distant metastases were the cause of death in 14 (74%) patients and distant and locoregional disease in 2 (10%) patients.

Reference

  1. Kumar A. Oral Abstract 72. Outcomes In Response To Aggressive Multimodal Therapy In Anaplastic Thyroid Cancer: The Mayo Clinic Experience. Presented at: 15th International Thyroid Congress and 85th Annual Meeting of the American Thyroid Association (ITC/ATA); Oct 18-23, 2015; Lake Buena Vista, Florida.

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