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Aggressive multimodal therapy may improve outcomes for anaplastic thyroid cancer
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LAKE BUENA VISTA, Fla. — Aggressive multimodal therapy appeared to prolong survival among patients with anaplastic thyroid cancer, especially those with lower-stage disease, according to study results presented at the International Thyroid Congress.
“Anaplastic thyroid cancer is a rare disease, accounting for about 1.7% of thyroid cancers in the U.S.,” Aditi Kumar, MD, endocrinologist at Mayo Clinic in Rochester, Minnesota, said during a presentation. “Studies suggest that anaplastic thyroid cancer accounts for between 14% and 39% of thyroid cancer deaths. This cancer has a terrible prognosis, with a historical median OS of only about 5 months, and 1-year survival estimates of less than 20%.”
However, in a small pilot series of patients (n = 10) with locoregionally-confined disease, aggressive multimodal therapy — comprised of combined surgery, radiation therapy and chemotherapy — appeared to confer a greater OS benefit. Median OS was 60 months, with 70% of patients alive at 1 year and 60% alive at 2 years.
Kumar reported outcomes in an expanded series of patients treated with aggressive multimodal therapy regardless of stage.
The researchers retrospectively reviewed the records of 56 patients with anaplastic thyroid cancer to select patients for the study. The study included data from 29 patients (median age, 60 years; 72% men).
The majority of patients (69%, n = 20) had stage IVB disease at diagnosis. The remaining patients had stage IVA (7%; n = 2) or stage IVC (24%; n = 7) disease. Kumar noted that because nearly all patients with anaplastic thyroid cancer present at a highly advanced stage, stage IVA is considered the lowest risk category.
Ninety-three percent of patients underwent surgery, from which 24% of patients achieved no residual tumor and 52% of patients were left with microscopic residual tumor.
All patients underwent chemotherapy. Sixty-six percent (n = 19) received chemotherapy with docetaxel and doxorubicin and 83% (n = 24) receiving chemotherapy with taxanes.
Further, all patients underwent definitive intensity modulated radiation therapy (IMRT; median, 66 Gy; range, 46-70; median fractions, 33). The majority of patients (83%; n = 24) completed treatment. The other patients discontinued IMRT due to toxicity (n = 4) or death (n = 1).
After a median follow-up of 24.5 months, median OS was 22.4 months. Rates of OS were 60% at 1 year, 48% at 3 years and 43% at 5 years.
Ten patients (34%) remained alive at time of reporting. Seventy-four percent of patients (n = 14) died of distant metastases and 10% (n = 2) died of distant and locoregional disease.
Age, extent of surgery or American Joint Committee on Cancer stage did not significantly influence survival.
Kumar noted a potential for selection bias due to the exclusion of patients the researchers thought would not be able to tolerate treatment.
“Our results suggest that although historical survival in anaplastic thyroid cancer has been very poor, aggressive multimodal therapy can result in longer-term OS, especially among patients with lower-stage disease,” Kumar said. “It must be noted, however, that such aggressive therapy comes at a cost, including frequent clinical provider contact and intensive therapies with a considerable amount of toxicities.” – by Cameron Kelsall
Reference:
Kumar A, et al. Oral Abstract 72. Presented at: International Thyroid Congress; Oct. 18-23, 2015; Lake Buena Vista, Fla.
Disclosure: The researchers report no relevant financial disclosures.