Neoadjuvant therapy in thyroid cancer: an emerging approach

Neoadjuvant therapy in thyroid cancer has emerged as a promising strategy for selected patients with locally advanced disease, but its rationale and clinical impact vary substantially across histologies.

This comment examines the current evidence and clinical rationale for neoadjuvant therapy across anaplastic, differentiated and medullary thyroid carcinomas.

For BRAF V600E-mutated anaplastic thyroid carcinoma, targeted therapy has created a meaningful window for surgical resection in patients previously considered unresectable, representing the clearest proof of concept. In differentiated thyroid cancer, preoperative systemic therapy remains more selective and investigational, mainly supported by case reports, small series, and early clinical trial data, with unresolved questions regarding patient selection, optimal treatment, surgical endpoints, and durability of benefit. With medullary thyroid carcinoma, evidence remains even more limited.

Neoadjuvant therapy should not be viewed as a uniform paradigm across thyroid cancers, but as a histology-specific strategy with applicability based on tumor responsiveness amounting to improved resectability, reduced surgical morbidity, durable disease control, and real-world feasibility.