Is emerging use of targeted therapy, immunotherapy, surgery, and radiation therapy associated with improved overall survival in patients with anaplastic thyroid carcinoma (ATC)?
In this single-institution cohort study of 479 patients with ATC spanning nearly 20 years, 1- and 2-year survival significantly increased from 35% and 18% in the 2000-2013 era (n = 227) to 47% and 25% in the 2014-2016 era (n = 100), and 59% and 42% in the 2017-2019 era (n = 152), respectively.
This study suggests that ATC may be effectively treated with highly specialized molecular-based personalized therapies, and surgery when appropriate, regardless of disease stage.
Anaplastic thyroid carcinoma (ATC) historically has a 4-month median overall survival (OS) from time of diagnosis, with disease-specific mortality approaching 100%. The association between recent major advancements in treatment and OS has yet to be evaluated.
To evaluate rates of OS in patients with ATC over the last 2 decades.
Design, Setting, and Participants
Retrospective cohort study in a single tertiary care institution. Patients with histopathological confirmation of ATC from January 2000 to October 2019 were included and divided into 3 groups according to date of presentation: 2000-2013, 2014-2016, and 2017-2019.
Main Outcomes and Measures
Overall survival compared among different treatment eras and differing therapies, including targeted therapy, immunotherapy, and surgery.
Of 479 patients (246 men [51%]; median age, 65.0 [range, 21.1-92.6] years) with ATC evaluated, 52 (11%) were stage IVA, 172 (36%) stage IVB, and 255 (53%) stage IVC at presentation. The median OS of the entire cohort was 0.79 years (9.5 months), ranging from 0.01 to 16.63. The OS at 1 and 2 years was 35% (95% CI, 29%-42%) and 18% (95% CI, 13%-23%) in the 2000-2013 group (n = 227), 47% (95% CI, 36%-56%) and 25% (95% CI, 17%-34%) in the 2014-2016 group (n = 100), and 59% (95% CI, 49%-67%) and 42% (95% CI, 30%-53%) in the 2017-2019 group (n = 152), respectively (P < .001). The hazard ratio was 0.50 (95% CI, 0.38-0.67) for the 2017-2019 group compared with the 2000-2013 patients (P < .001). Factors associated with improved OS included targeted therapy (hazard ratio, 0.49; 95% CI, 0.39-0.63; P < .001), the addition of immunotherapy to targeted therapy (hazard ratio, 0.58; 95% CI, 0.36-0.94; P = .03), and surgery following neoadjuvant BRAF-directed therapy (hazard ratio, 0.29; 95% CI, 0.10-0.78; P = .02). Patients undergoing surgery following neoadjuvant BRAF-directed therapy (n = 20) had a 94% 1-year survival with a median follow-up of 1.21 years.
Conclusion and Relevance
In this large single-institution cohort study spanning nearly 20 years, changes in patient management appear to be associated with significant increase in survival. The era of untreatable ATC is progressively being replaced by molecular-based personalized therapies, with integration of multidisciplinary therapies including surgery and radiation therapy.
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Maniakas A, Dadu R, Busaidy NL, et al. Evaluation of Overall Survival in Patients With Anaplastic Thyroid Carcinoma, 2000-2019. JAMA Oncol. 2020;6(9):1397–1404. doi:10.1001/jamaoncol.2020.3362
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