Targeted Treatment Tied to Longer Survival in Patients With Anaplastic Thyroid Cancer

By David Douglas

August 21, 2020

NEW YORK (Reuters Health) - With the introduction of targeted treatments for anaplastic thyroid carcinoma, patients have seen significant improvements in survival, according to a new report.

"Over the last 5 years, a greater understanding of the molecular genetics of anaplastic thyroid cancer has led to more personalized treatment strategies, which has greatly improved survival in these patients," Dr. Maria E. Cabanillas of The University of Texas MD Anderson Cancer Center, in Houston, told Reuters Health by email.

She and her colleagues examined data on 479 patients who were treated at their institution between 2000 and 2019. The patients' median age was 65 years, and at presentation 11% were stage IVA, 36% were stage IVB and the remaining 53% were stage IVC.

The median overall survival (OS) was 9.5 months, the researchers report in JAMA Oncology.

Overall survival at one year in the 227 patients treated between 2000 and 2013 was 35%, dropping to 18% at two years. For the 100 treated between 2014 and 2016, survival was 47% and 25%, respectively, and for those treated between 2017 and 2019, 59% and 42% (P<0.001).

"Recent work has demonstrated feasibility of complete resection and locoregional disease control when patients with BRAF V600E-variant tumors undergo surgical resection following neoadjuvant BRAF-directed therapy," the researchers note.

Molecular testing for the BRAF V600E variation was done in 17% of the 2000-2013 group, 82% of the 2014-2016 group, and 97% of the 2017-2019 group. Significantly more patients received targeted therapy in the 2017-2019 group (61%) compared with the 2000-2013 group (9%) and the 2014-2016 group (43%). When including only patients having been tested for the BRAF variation, these values were 65%, 26% and 46%.

On multivariate analysis, OS was significantly better in 2017-19 than in 2000-13 (hazard ratio, 0.50; P<0.001). For those treated during 2014-16, the HR was 0.77 (P=0.06).

Factors significantly associated with improved OS included targeted therapy, addition of immunotherapy to targeted therapy and surgery following neoadjuvant BRAF-directed therapy. In the 20 patients who underwent such surgery, survival at one year was 94%.

"With this largest single-institution study, we have demonstrated that rapid molecular genetic tumor testing, personalized targeted therapies, immunotherapy, and surgery, can revolutionize the landscape of a disease that only a few years ago was considered untreatable and rapidly fatal," concluded Dr. Cabanillas.

SOURCE: https://bit.ly/31SPtfU JAMA Oncology, online August 6, 2020

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