From the Guidelines
The recommended treatment approach for poorly differentiated invasive carcinoma is platinum-based combination chemotherapy, as it has shown to be effective in improving survival rates and providing relief of symptoms. This approach is based on the most recent and highest quality study available, which suggests that platinum-based combination chemotherapy is the most effective treatment option for poorly differentiated invasive carcinoma, particularly for patients with predominantly nodal disease 1.
Treatment Options
- Platinum-based combination chemotherapy is the recommended treatment approach for poorly differentiated invasive carcinoma, particularly for patients with predominantly nodal disease.
- The combination of cisplatin and etoposide is also a viable option for poorly differentiated neuroendocrine carcinomas.
- For patients with peritoneal carcinomatosis of a serous histologic type adenocarcinoma, optimal surgical debulking followed by platinum-based chemotherapy is recommended.
- Isolated axillary nodal metastases in female patients can be treated with axillary nodal dissection, mastectomy, or breast irradiation, and adjuvant chemohormonotherapy.
Rationale
The rationale behind this treatment approach is that poorly differentiated carcinomas tend to behave more aggressively with higher rates of metastasis and recurrence due to their lack of cellular organization and rapid growth patterns. Therefore, an aggressive treatment approach is necessary to improve survival rates and provide relief of symptoms.
Patient Factors
Treatment must be tailored to the specific cancer type, location, stage, and patient factors, including performance status and comorbidities, ideally determined through multidisciplinary tumor board discussion. Patient factors such as age, overall health, and presence of comorbidities must be taken into account when determining the best course of treatment.
Additional Considerations
Additional considerations, such as the use of targeted therapies and immunotherapy, should be based on biomarker testing results, particularly for PD-L1 expression or specific genetic alterations. The use of these therapies can help improve treatment outcomes and provide additional treatment options for patients with poorly differentiated invasive carcinoma.
From the Research
Treatment Approaches for Poorly Differentiated Invasive Carcinoma
The treatment approach for poorly differentiated invasive carcinoma depends on the specific type and location of the cancer.
- For poorly differentiated colorectal carcinoma with invasion restricted to the lamina propria, polypectomy may be adequate treatment, as these carcinomas lack access to lymphatics and therefore have no potential for metastases 2.
- For invasive differentiated thyroid cancer, a multimodality treatment approach is required, including surgery, adjuvant therapy, and possibly external beam radiotherapy 3, 4.
- For locally advanced unresectable head and neck cancer, induction chemotherapy with paclitaxel, carboplatin, and cetuximab may be a tolerable and potential option for patients ineligible for combination treatment with docetaxel, cisplatin, and 5-fluorouracil 5.
- For poorly differentiated thyroid carcinomas, a comprehensive review of diagnostic and therapeutic tools is necessary, including histocytology, immunohistochemistry, and molecular genetics tests 4.
Key Considerations
- The extent of disease and patient characteristics should be carefully assessed prior to embarking on surgery 3.
- A multidisciplinary approach to investigation and treatment is necessary for patients with invasive differentiated thyroid cancer 3.
- The role of external beam radiotherapy continues to evolve in the treatment of differentiated thyroid cancer, with support for its use in patients considered to have radioactive iodine-resistant tumors 3.