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Anaplastic Thyroid Carcinoma: Current Issues in Genomics and Therapeutics. Curr Oncol Rep 2021; 23:31. [PMID: 33582932 DOI: 10.1007/s11912-021-01019-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Anaplastic thyroid carcinoma is a type of thyroid carcinoma with the most aggressive biological behaviour amongst thyroid cancer. Here, we review the current genomic and the impacts of advances in therapies to improve the management of patients with the cancer. RECENT FINDINGS Common mutations being identified in anaplastic thyroid carcinoma are p53 and TERT promoter mutations. Other common mutated genes included BRAF, RAS, EIF1AX, PIK3CA, PTEN and AKT1, SWI/SNF, ALK and CDKN2A. Changes in expression of different microRNAs are also involved in the pathogenesis of anaplastic thyroid carcinoma. Curative resection combined with radiotherapy and combination chemotherapies (such as anthracyclines, platins and taxanes) has been shown to have effects in the treatment of some patients with anaplastic thyroid carcinoma. Newer molecular targeted therapies in clinical trials target mostly the cell membrane kinase and downstream proteins. These include targeting the EGFR, FGFR, VEGFR, c-kit, PDGFR and RET on the cell membrane as well as VEGF itself and the downstream targets such as BRAF, MEK and mTOR. Immunotherapy is also being tested in the cancer. Updated knowledge of genomic as well as clinical trials on novel therapies is needed to improve the management of the patients with this aggressive cancer.
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Shi X, Liu R, Qu S, Zhu G, Bishop J, Liu X, Sun H, Shan Z, Wang E, Luo Y, Yang X, Zhao J, Du J, El-Naggar AK, Teng W, Xing M. Association of TERT promoter mutation 1,295,228 C>T with BRAF V600E mutation, older patient age, and distant metastasis in anaplastic thyroid cancer. J Clin Endocrinol Metab 2015; 100:E632-7. [PMID: 25584719 PMCID: PMC4399285 DOI: 10.1210/jc.2014-3606] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The aggressive role of TERT promoter mutations has been well established in differentiated thyroid cancer but has not been established in anaplastic thyroid cancer (ATC). RESEARCH DESIGN We tested the mutation status by sequencing genomic tumor DNA and examined its relationship with clinicopathological characteristics of ATC. RESULTS Among 106 American and Chinese ATC samples, TERT 1,295,228 C>T (termed TERT C228T) mutation was found in 37 (34.9%) cases, TERT promoter mutation 1,295,250 C>T was found in four cases (3.8%), and the two mutations were mutually exclusive and collectively found in 41 cases (38.7%). TERT C228T occurred in 28 of 90 (31.1%) wild-type BRAF cases vs nine of 16 (56.3%) BRAF V600E cases, with an odds ratio of 2.85 (95% confidence interval, 0.96-8.42; P = .05). Patient age was 67.6 ± 13.6 vs 61.6 ± 11.4 years in the TERT C228T vs wild-type TERT patients (P = .02), demonstrating an association between TERT C228T and older patient age. This association was also seen within the American cohort. In this cohort, which had more available clinicopathological data, TERT C228T was associated with distant metastasis of the tumor; specifically, distant metastasis occurred in 15 of 18 (83.3%) TERT C228T patients vs eight of 26 (30.8%) wild-type TERT patients, with an odds ratio of 11.25 (95% confidence interval, 2.53-50.08; P = .001). No association was found with patient sex, tumor size, lymph node metastasis, and extrathyroidal invasion of ATC. CONCLUSIONS This is the largest study on the aggressive role of TERT promoter mutations in ATC, demonstrating an association of TERT C228T with BRAF V600E, older patient age, and tumor distant metastasis in ATC.
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Affiliation(s)
- Xiaoguang Shi
- Laboratory for Cellular and Molecular Thyroid Research (X.S., R.L., G.Z., X.L., M.X.), Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Department of Endocrinology & Metabolism (S.Q.), Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China; Department of Pathology (J.B.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Jilin Provincial Key Laboratory of Surgical Translational Medicine (H.S.), Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin Province 130033, China; Department of Pathology (E.W.), The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province 110001, China; Department of Medical Image (Y.L.), Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province 110001, China; Department of Pathology (X.Y.), Shengjing Hospital of China Medical University, Shenyang, Liaoning Province 110004, China; Department of Endocrinology (J.Z.), Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province 250021, China; Department of Endocrinology (J.D.), The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province 116011, China; Department of Pathology (A.K.E.-N.), University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030; and The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases (X.S., Z.S., W.T.), Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, Liaoning Province 110001, China
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