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Personalized therapy improves anaplastic thyroid cancer outcomes
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CHICAGO — The era of untreatable anaplastic thyroid cancer is progressively being replaced by highly specific molecularbased personalized therapy, according to a presenter at the Annual Meeting of the American Thyroid Association.
“We all know that anaplastic thyroid cancer is a rare disease, but is the deadliest of all thyroid cancers,” Anastasios Maniakas, MD, MSc, researcher in the department of head and neck surgery at The University of Texas MD Anderson Cancer Center, said during a presentation. “However, landmark changes in the overall management of these patients during the past 5 years have led to significant increases in OS.”
Data from a SEER database analysis including more than 1,500 patients diagnosed with anaplastic thyroid cancer between 1986 and 2015 showed a median survival of only 4 months and 6-month survival below 35%.
However, results from a 2017 study published in the Journal of Clinical Endocrinology and Metabolism showed a median 1-year OS of 42% among 48 patients with anaplastic thyroid cancer who received multimodal therapy between 2003 and 2015.
“Additionally, a 2014 project that we implemented known as the Facilitating Anaplastic Thyroid Cancer Specialized Treatment (FAST) project aims to decrease time from referral to treatment disposition,” Maniakas said. “This project has helped lead to new treatment options for these patients, such as the 2017 FDA-approval of dabrafenib (Tafinlar, Novartis) plus the MEK inhibitor trametinib (Mekinist, Novartis) in those with BRAF V600E-mutant anaplastic thyroid cancer. This approval opened the door for future gene-targeted research for this rare disease.”
For the current statistical analysis, Maniakas and colleagues assessed changes in OS among 479 patients (median age, 65; 51% men) with histopathological confirmation of anaplastic thyroid cancer between 2000 and 2019.
Researchers divided patients into categories according to date of diagnosis: 2000 to 2013 (n = 227), 2014 to 2016 (n = 100) and 2017 to 2019 (n = 152).
After a median follow-up of 5.4 months (range, 0-31.9), 337 patient deaths had occurred.
Results of Kaplan-Meier estimates for 2-year survival were 16.5% for the 2000 to 2013 group, 19.5% for the 2014 to 2016 group and 36.5% for the 2017 to 2019 group (P < .001).
“Over the years, patient groups experienced significant differences in treatment options available, including increased use of targeted therapy, increased enrollment in clinical trials and increased use of surgery in the neoadjuvant setting,” Maniakas said.
OS significantly increased from a median of 8 months in the 2000 to 2013 group to 16 months in the 2017 to 2019 group (HR = 0.66; 95% CI, 0.53-0.82).
OS for the 2017 to 2019 group was 80% at 6 months, 59% at 1 year and 43% at 2 years.
The HR for death was 0.756 for the 2017 to 2019 group compared with the 2000 to 2016 combined group (P < .001).
“To achieve this survival benefit, it has been a multifaceted, specialized effort,” Maniakas said. “We have become more efficient and more precise in seeing our patients and testing them for genetic alterations, which has subsequently improved our ability to properly utilize targeted therapy while introducing novel uses for immunotherapy and intervening with surgery or radiation therapy.”
These findings suggest the need for updated recommendations to the anaplastic thyroid cancer guidelines, Maniakas said.
“We recommend quick and efficient patient referral to a specialized cancer center, rapid molecular testing for all patients with anaplastic thyroid cancer, timely initiation of targeted therapy, eligible patients should be enrolled on clinical trials when appropriate and patients should be considered for surgical resection after neoadjuvant therapy,” he said. – by Jennifer Southall
Reference:
Maniakas A, et al. Short Call Oral Abstract 9. Presented at: Annual Meeting of the American Thyroid Association; Oct. 30-Nov. 3, 2019; Chicago.
Disclosures: Maniakas reports no relevant financial disclosures.