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Multimodal therapy increases anaplastic thyroid cancer survival
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Adults who receive intensive multimodal therapy for treatment of anaplastic thyroid cancer are likely to have longer progression-free survival and overall survival compared with those treated with palliative therapy, study data show.
“Anaplastic thyroid cancer is a deadly and historically almost uniformly fatal cancer, with perhaps the worst historical prognosis of most any cancer,” Keith C. Bible, MD, PhD, chair of the general and endocrine center care teams in the division of medical oncology and chair of the endocrine malignancies disease group at the Mayo Clinic Cancer Center, told Endocrine Today. “This study suggests, however, that if treated early and with multimodal therapy, patients with nonmetastatic anaplastic thyroid cancer have potential to attain longer-term survival. Aggressive multimodal therapy, however, is associated with considerable toxicities; these toxicities must be carefully considered and weighed in decision-making by patients and providers.”
Bible and colleagues evaluated 48 adults (60% men; median age, 62 years) with newly diagnosed anaplastic thyroid cancer treated with multimodal (n = 30) or palliative therapy (n = 18) to determine whether initial intensive multimodal therapy that combined surgery, chemotherapy and radiation is associated with increased survival. Median follow-up was 6.8 months for all participants, 20.3 months for the multimodal therapy group and 3.8 months for the palliative therapy group.
Data from participants in the current study were compared with those within the cohort as well as with data from a 1949 to 1999 patient cohort.
American Joint Committee on Cancer data were used to define cancer stages; two participants had stage IVA, 27 stage IVB and 18 stage IVC anaplastic thyroid cancer.
Overall, median overall survival was 8.8 months in the present combined study cohort compared with a median 3 months overall survival in the 1949 to 1999 cohort.
Median overall survival was greater in the multimodal therapy group (21 months) compared with the palliative intention cohort (4 months; P = .0006).
Participants in the current study with stage IVB cancer were evaluated separately and compared based on care. Median progression-free survival was longer in the multimodal therapy group compared with the palliative intention group (9.4 months vs. 2.8 months; P < .0001). Median overall survival was also longer in the multimodal therapy group compared with the palliative intention therapy group (22.4 months vs. 4 months; P = .0001).
No differences in survival were found between the multimodal therapy and palliative intention therapy groups in stage IVC.
“There is increasing evidence that aggressive initial multimodal therapy in nonmetastatic anaplastic thyroid cancer is associated with improved overall survival compared to more conservative treatments,” Bible said. “Hence, initial multimodal therapy should be considered in patients with nonmetastatic anaplastic thyroid cancer. More randomized trials are needed in anaplastic thyroid cancer of all stages so as to more definitively establish best approaches to treatment and care.” – by Amber Cox
For more information:
Keith C. Bible, MD, PhD, can be reached at bible.keith@mayo.edu.
Disclosures: The authors report no relevant financial disclosures.
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Prasongsook and colleagues performed a single-institution study evaluating outcomes of multimodality treatment, defined as intensity-modulated radiation therapy plus concurrent chemotherapy, vs. treatment with palliative intent in 48 patients with anaplastic thyroid cancer. Only two patients had stage IVA disease, and these patients were alive more than 5 years after multimodality treatment. In comparison, 18 patients had stage IVC disease, and these patients did poorly regardless of treatment. Of the stage IVB patients treated with multimodality therapy between 2003 and 2015, 68% were alive at 1 year compared with none who underwent palliative treatment. According to the authors, approximately 30% of the stage IVB patients who received multimodality treatment were still alive 5 years from diagnosis. The authors acknowledge the limitations of this study: largely, the low sample size secondary to the rarity of anaplastic thyroid cancer, the single-institution study design, and the risk for bias/confounding by indication. The authors tried to reduce confounding by indication by separately evaluating patients with IVB disease, but even in this subset, it is still probable that selection of treatment is based on other factors that may also correlate with better or worse survival, including disease severity, comorbidity, frailty and age. Despite limitations, anaplastic thyroid cancer is rare and deadly, and any insight into tailoring treatment to improve outcomes is a step in the right direction. However, more comprehensive, multicenter studies are needed.
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