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Updated: May 27, 2025
Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Transforming thyroid cancer management: the impact of neoadjuvant therapy
Abstract:
Neoadjuvant therapy has an emerging role in the management of locally advanced thyroid cancer. Recent developments in systemic therapies, particularly with the introduction of multikinase inhibitors and selective inhibitors, have demonstrated promising results. The objective of this review is to delve into the implications of these developments and their potential impact on the management of advanced thyroid cancers, which initially present as borderline resectable or unresectable. For differentiated thyroid cancer and poorly differentiated thyroid cancer, agents such as lenvatinib have shown substantial tumor reduction, facilitating surgical resection. Similarly, for medullary thyroid cancer, selpercatinib have exhibited interesting response rates, enhancing the feasibility of surgery with reduced morbidity in limited clinical case series of patients with RET mutations. In BRAF mutant ATC, the combination of BRAF and MEK inhibitors has significantly improved treatment protocols, providing a pathway to surgical intervention and significantly improving survival rates. The addition of immune checkpoint inhibitors to these regimens showed further extension of survival and reduced recurrence rates in retrospective studies that still need confirmation. Despite these preliminary favorable results, neoadjuvant therapies are not without challenges. The risk of adverse events, particularly related to the inhibition of the VEGF pathway, necessitates careful patient selection and management. The variability in tumor responses and the potential for serious complications underscore the need for continued research to refine these approaches in this difficult patient population.
Insights
Neoadjuvant therapies, including multikinase inhibitors, show promise in reducing advanced thyroid tumors for surgery. Careful patient selection is crucial due to potential adverse events and variable responses.
Area of Science:
- Oncology
- Endocrinology
- Cancer Therapeutics
Background:
- Locally advanced thyroid cancer often presents as borderline resectable or unresectable.
- Systemic therapies are increasingly explored as neoadjuvant treatments for advanced thyroid cancer.
- Multikinase inhibitors and selective inhibitors represent recent advancements in this field.
Purpose of the Study:
- To review the implications of novel systemic therapies in managing advanced thyroid cancers.
- To assess the potential impact of neoadjuvant treatments on surgical resectability and patient outcomes.
- To highlight challenges and future research directions for neoadjuvant therapy in thyroid cancer.
Main Methods:
- Literature review of recent developments in systemic therapies for advanced thyroid cancer.
- Analysis of clinical data on agents like lenvatinib, selpercatinib, and BRAF/MEK inhibitors.
- Evaluation of retrospective studies on immune checkpoint inhibitors in neoadjuvant settings.
Main Results:
- Lenvatinib demonstrates significant tumor reduction in differentiated and poorly differentiated thyroid cancer, aiding resection.
- Selpercatinib shows promising response rates in medullary thyroid cancer with RET mutations, improving surgical feasibility.
- BRAF/MEK inhibitor combinations improve outcomes in BRAF-mutant anaplastic thyroid cancer, enabling surgical intervention and survival benefits.
Conclusions:
- Neoadjuvant systemic therapies offer a viable strategy for improving surgical outcomes in advanced thyroid cancer.
- Challenges include managing adverse events, particularly VEGF pathway inhibition, and addressing response variability.
- Further research is essential to optimize neoadjuvant approaches and patient selection for improved survival and reduced morbidity.
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