Clinical trials in management of anaplastic thyroid carcinoma; progressions and set backs: A systematic review

Abstract

Context: Anaplastic thyroid carcinoma (ATC) is associated with rapid tumor growth and extremely poor prognosis. Although ATC is found in only 2% of all thyroid carcinomas, it accounts for up to 50% of thyroid cancer mortality. Objective: To understand the effect of different treatment modalities upon anaplastic thyroid cancer outcomes. Methods: A systematic review of studies from 1995 to 2017 was performed employing the search terms “anaplastic thyroid” and “treatment” in PubMed. Studies comparing patients receiving any type of therapy for ATC and measuring either survival as primary outcome or the percentage of patient surviving more than 1 year as secondary outcome were included for review. We did not limit sample size or subject condition. A total of 40 articles were returned from our database search, of which 25 met the inclusion criteria. Results: A review of the 25 published studies indicated that early multidisciplinary approaches using extensive radical surgery, in combination with adjuvant chemo-radiation using either docetaxel/pacitaxel or cisplatin, provided the best chance of disease control. Targeted multi-tyrosine kinases inhibitors helped to limit disease progression. Also, the finding of foci of differentiated thyroid cancer within the anaplastic tumor was associated with increased long-term survival. Conclusions: ATC remains a fatal disease. Despite aggressive therapy the median survival has not significantly changed over the last 20 years. However, the percentage of patients surviving longer than 1 year continues to increase. Novel approaches incorporating multiple targeted therapy and immune therapies are critically needed.