Advances in the management of anaplastic thyroid carcinoma: transforming a life-threatening condition into a potentially treatable disease.
Inés CalifanoAnabella SmuleverFernando JerkovichFabián PitoiaPublished in: Reviews in endocrine & metabolic disorders (2023)
Anaplastic thyroid cancer (ATC) is an infrequent thyroid tumor that usually occurs in elderly patients. There is often a history of previous differentiated thyroid cancer suggesting a biological progression. It is clinically characterized by a locally invasive cervical mass of rapid onset. Metastases are found at diagnosis in 50% of patients. Due to its adverse prognosis, a prompt diagnosis is crucial. In patients with unresectable or metastatic disease, multimodal therapy (chemotherapy and external beam radiotherapy) has yielded poor outcomes with 12-month overall survival of less than 20%. Recently, significant progress has been made in understanding the oncogenic pathways of ATC, leading to the identification of BRAF V600E mutations as the driver oncogene in nearly 40% of cases. The combination of the BRAF inhibitor dabrafenib (D) and MEK inhibitor trametinib (T) showed outstanding response rates in BRAF-mutated ATC and is now considered the standard of care in this setting. Recently, it was shown that neoadjuvant use of DT followed by surgery achieved 24-month overall survival rates of 80%. Although these approaches have changed the management of ATC, effective therapies are still needed for patients with BRAF wild-type ATC, and high-quality evidence is lacking for most aspects of this neoplasia. Additionally, in real-world settings, timely access to multidisciplinary care, molecular testing, and targeted therapies continues to be a challenge. Health policies are warranted to ensure specialized treatment for ATC.The expanding knowledge of ATC´s molecular biology, in addition to the ongoing clinical trials provides hope for the development of further therapeutic options.
Keyphrases
- wild type
- healthcare
- locally advanced
- palliative care
- clinical trial
- end stage renal disease
- public health
- squamous cell carcinoma
- rectal cancer
- quality improvement
- metastatic colorectal cancer
- pain management
- ejection fraction
- minimally invasive
- newly diagnosed
- early stage
- type diabetes
- radiation therapy
- lymph node
- prognostic factors
- risk assessment
- chronic kidney disease
- free survival
- stem cells
- metabolic syndrome
- high grade
- peritoneal dialysis
- adipose tissue
- health information
- radiation induced
- weight loss
- cell proliferation
- transcription factor
- atrial fibrillation
- electronic health record
- cell therapy
- sensitive detection
- replacement therapy
- bioinformatics analysis
- phase ii