Personalized treatment of 95 poorly differentiated thyroid cancer/anaplastic thyroid cancer in 2019-2023
Nai-Si Huang1,2, Jia-Ying Chen1,2, Wen-Jun Wei1,2
1Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Background:
Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) are both rare and aggressive thyroid cancers. Advances in targeted therapy and immunotherapy have changed treatment strategies and improved prognosis in these patients.
Methods:
This single-center cohort study included patients diagnosed with locally advanced or metastatic PDTC/ATC at Fudan University Shanghai Cancer Center (FUSCC) between 2019 and 2023. Patients were either enrolled in clinical trials or received treatment based on clinical guidelines and expert consensus. Gene testing was conducted using next-generation sequencing of clinical samples.
Results:
95 patients were analyzed (PDTC = 34, ATC = 61). Median overall survival (OS) was 19.7 months for PDTC and 9.5 months for ATC (P = 0.478). Among 82 patients who underwent gene testing, the most frequent gene alterations in PDTC were BRAF (50.0%), TERT promoter (39.3%), and TP53 (25.0%) mutations; in ATC, they were TERT promoter (55.6%), BRAF (42.6%), and TP53 (25.9%) mutations. Compared with ATC patients, PDTC patients were more likely to receive best supportive care and less likely to be enrolled in clinical trials or treated with PD-1 inhibitors. The 1-year OS rates for PDTC/ATC patients receiving neoadjuvant therapy + surgery, systemic treatment, and supportive care only were 83.3, 51.2, and 5.7%, respectively (P < 0.001). After adjusting for covariates, neoadjuvant therapy + surgery (hazard ratio = 0.216, 95% confidence interval: 0.647-0.718, P = 0.012) was an independent predictor of superior OS.
Conclusion:
Despite the generally poor prognosis, aggressive treatment, particularly neoadjuvant therapy, has been shown to improve survival. Personalized treatment is crucial for optimizing treatment strategies for PDTC/ATC.
Insights
Aggressive treatments, including neoadjuvant therapy, significantly improve survival for patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC). Personalized treatment strategies are essential for better outcomes in these rare and aggressive thyroid cancers.
Area of Science:
- Oncology
- Thyroid Cancer Research
- Cancer Therapeutics
Background:
- Poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) are rare, aggressive forms of thyroid cancer.
- Recent advances in targeted therapy and immunotherapy offer new treatment avenues and improved prognoses for patients.
- Understanding treatment efficacy and genetic alterations is crucial for managing these challenging malignancies.
Purpose of the Study:
- To analyze treatment strategies and outcomes for patients with locally advanced or metastatic PDTC/ATC.
- To identify common gene alterations in PDTC and ATC.
- To evaluate the impact of different treatment modalities on overall survival.
Main Methods:
- Single-center cohort study of 95 patients with PDTC/ATC diagnosed between 2019-2023.
- Patients received treatment via clinical trials, guidelines, or expert consensus.
- Next-generation sequencing was used for gene testing on clinical samples.
Main Results:
- Median overall survival (OS) was 19.7 months for PDTC and 9.5 months for ATC.
- Frequent gene alterations included TERT promoter, BRAF, and TP53 mutations in both PDTC and ATC.
- Neoadjuvant therapy followed by surgery was an independent predictor of superior OS (HR=0.216, P=0.012).
Conclusions:
- Aggressive treatment, especially neoadjuvant therapy combined with surgery, significantly improves survival in PDTC/ATC patients.
- Personalized treatment approaches are vital for optimizing therapeutic strategies.
- Further research into targeted therapies and immunotherapies is warranted for these aggressive thyroid cancers.
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