From the Guidelines
Management of anaplastic thyroid carcinoma in the Philippines should prioritize a multidisciplinary approach, focusing on surgical resection when possible, followed by concurrent chemoradiation therapy, and considering targeted therapy or immunotherapy for eligible patients, with a strong emphasis on supportive care and individualized treatment decisions based on disease extent, patient performance status, and available resources. The treatment of anaplastic thyroid carcinoma (ATC) is challenging due to its aggressive nature and poor prognosis, with a median survival of 3-6 months 1.
Key Considerations
- Surgical resection is rarely possible but may be considered in localized cases with no distant metastasis (M0) 1.
- Concurrent chemoradiation therapy is a standard approach, although the optimal chemotherapy regimen is not well established, with options including docetaxel or paclitaxel combined with external beam radiation therapy 1.
- Targeted therapy, such as dabrafenib plus trametinib for patients with BRAF V600E mutations, or immunotherapy with pembrolizumab for advanced cases, may be considered, but high-level evidence supporting their use is limited 1.
- Supportive care, including pain management, nutritional support, and psychological counseling, is essential to improve quality of life (QoL) in patients with ATC.
- Early tracheostomy may be necessary to maintain airway patency in patients with moderately progressive disease, but its impact on QoL must be carefully considered 1.
Treatment Approach
- The most recent and highest quality study recommends a multidisciplinary approach, with surgical resection, concurrent chemoradiation therapy, and targeted therapy or immunotherapy as potential treatment options 1.
- Treatment decisions should be individualized based on disease extent, patient performance status, and available resources within the Philippine healthcare system.
- Palliative care and supportive measures should be prioritized to improve QoL and alleviate symptoms in patients with advanced ATC.
From the Research
Management of Anaplastic Thyroid Carcinoma in the Philippines
- The management of anaplastic thyroid carcinoma (ATC) in the Philippines involves a multidisciplinary approach, including surgery, radiotherapy, and chemotherapy 2.
- According to a study conducted at the Philippine General Hospital, curative surgery offers the most effective means of prolonging survival, while radiotherapy and chemotherapy in combination with surgery represents a promising treatment strategy 3.
- The study also found that an absence of distant metastases and lymph node involvement was associated with improved survival outcomes, whereas age at diagnosis and tumor size did not affect survival 3.
Treatment Options
- Surgery: Curative surgery is recommended for patients with localized disease, while palliative surgery may be considered for patients with advanced disease 4, 3.
- Radiotherapy: Adjuvant chemo-radiotherapy is recommended for patients with localized disease, while decompressive cervical radiotherapy may be considered for patients with locally advanced or metastatic disease 4, 5.
- Chemotherapy: Chemotherapy, including doxorubicin or taxanes, may be considered for patients with advanced disease, while targeted therapy, including kinase inhibitors, may be considered for patients with specific genetic mutations 6.
Prognosis and Survival
- The prognosis for ATC is generally poor, with a median overall survival of 3-10 months 4, 5, 3.
- However, a study found that an aggressive approach, including surgery, chemotherapy, and radiotherapy, may improve survival, with some patients surviving for more than 3 years 5.
- The study conducted at the Philippine General Hospital found that the median survival time for patients with ATC was 3 months, with only two patients confirmed to still be alive during the study period 3.
Current Knowledge and Perspectives
- Recent advances in the management of ATC include the use of molecular tests for targeted therapies and the integration of fast-track dedicated care pathways for patients in tertiary centers 4.
- The use of kinase inhibitors, including multitarget tyrosine kinase inhibitors and single target tyrosine kinase inhibitors, may improve survival outcomes for patients with ATC 6.
- Further research is needed to improve the management of ATC, including the development of new treatment options and the evaluation of combination therapies 6.