How is anaplastic thyroid carcinoma treated?

Updated: May 09, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The progression of disease is rapid, and most patients die from local airway obstruction or complications of pulmonary metastases within 1 year despite all treatment efforts. Total or subtotal thyroidectomy is performed when the extent of the permits it. Neck dissection is added to manage palpable cervical metastases. Complete excision is often impossible because many patients present with clinically significant local extension. Tracheal and laryngeal resection is usually not performed to remove disease because of the poor prognosis in these circumstances. Tracheotomy is needed in cases with airway compromise due to tracheal invasion. External-beam irradiation is effective in improving local control. It is added postoperatively or used as primary treatment in unresectable cases. Chemotherapy is added for palliation. Doxorubicin is the most commonly used chemotherapeutic agent. Chemotherapy and radiation therapy typically administered used in combination.

In May 2018, dabrafenib used in combination with trametinib became the first FDA-approved treatment for locally advanced or metastatic anaplastic thyroid cancer with BRAF V600E mutation in patients with no satisfactory alternatives for locoregional therapy. Approval came following a nine-cohort, multicenter, nonrandomized, open-label trial involving patients with BRAF V600E mutation–positive cancer. Investigators found that 57% of patients with anaplastic thyroid cancer experienced a partial response to the treatment, and 4% had a complete response. Sixty-four percent of the patients who responded suffered no significant tumor growths for at least 6 months. [28, 29]


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