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Zhou SY, Luo LX. An overview of the contemporary diagnosis and management approaches for anaplastic thyroid carcinoma. World J Clin Oncol 2024; 15:674-676. [PMID: 38946831 PMCID: PMC11212606 DOI: 10.5306/wjco.v15.i6.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 04/18/2024] [Indexed: 06/24/2024] Open
Abstract
Thyroid carcinoma is a complex disease with several types, the most common being well-differentiated and undifferentiated. The latter, "undifferentiated carcinoma", also known as anaplastic thyroid carcinoma (ATC), is a highly aggressive malignant tumor accounting for less than 0.2% of all thyroid carcinomas and carries a poor prognosis with a median survival of 5 months. BRAF gene mutations are the most common molecular factor associated with this type of thyroid carcinoma. Recent advances in targeted biological agents, immunotherapy, stem cell therapy, nanotechnology, the dabrafenib/trametinib combination therapy, immune checkpoint inhibitors (ICI) and artificial intelligence offer novel treatment options. The combination therapy of dabrafenib and trametinib is the current standard treatment for patients with BRAF-V600E gene mutations. Besides, the dabrafenib/trametinib combination therapy, ICI, used alone or in combination with targeted therapies have raised some hopes for improving the prognosis of this deadly disease. Younger age, earlier tumor stage and radiotherapy are all prognostic factors for improved outcomes. Ultimately, therapeutic regimens should be tailored to the individual patient based on surveillance and epidemiological data, and a multidisciplinary approach is essential.
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Affiliation(s)
- Shu-Yue Zhou
- The First Clinical College, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
| | - Lian-Xiang Luo
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China
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Wu G, Song Y, Yang S, Li H, Liu S, Gui L, Ni S. The role of targeted therapy and/or immunotherapy therapy in anaplastic thyroid carcinoma. Endocrine 2024; 84:1013-1020. [PMID: 38146047 DOI: 10.1007/s12020-023-03647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Anaplastic thyroid carcinoma (ATC) is a highly invasive malignant tumor with a poor prognosis. Traditional treatment methods have not been effective. However, advancements in targeted therapy and immunotherapy in recent years have shed new light on the management of ATC. The aim of this study was to examine the treatment plan and prognostic factors of ATC. METHODS This study conducted a retrospective analysis of ATC patients who received treatment at our institution between 2000 and 2023 to evaluate the clinical characteristics, treatment methods, and factors influencing survival. Survival analysis was performed by the Kaplan‒Meier method and log-rank test, and multivariate analysis was performed using the Cox proportional hazard model. RESULTS The 6-month and 1-year disease-specific OS rates were 49% and 29%, respectively. The presence of clinical symptoms and the timing of treatment significantly impacted patient prognosis (P < 0.05). Compared with surgery + radiotherapy/chemotherapy and only surgery, targeted therapy and targeted + immunotherapy represented an improved overall survival, The 6-month/1-year survival rates of which were 81%/61% and 91%/73% (P < 0.05), respectively. Multivariate analysis indicated that the symptoms at initial diagnosis, year of presentation, performance status and treatment plan were independent factors affecting the prognosis. The year of presentation (P = 0.048) and the treatment plan (P = 0.038) were significantly meaningful in predicting prognosis. CONCLUSION Targeted therapy and targeted+immune therapy can effectively prolong the survival period of ATC patients. Symptoms at initial diagnosis and treatment plan have a significant impact on the prognosis.
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Affiliation(s)
- Guoliang Wu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yixuan Song
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Han Li
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China.
| | - Song Ni
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Zhu L, Liang R, Guo Y, Cai Y, Song F, Hu Y, Liu Y, Ge M, Zheng G. Incorporating Network Pharmacology and Experimental Validation to Identify Bioactive Compounds and Potential Mechanisms of Digitalis in Treating Anaplastic Thyroid Cancer. ACS OMEGA 2024; 9:15590-15602. [PMID: 38585091 PMCID: PMC10993403 DOI: 10.1021/acsomega.4c00373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024]
Abstract
Anaplastic thyroid cancer (ATC) is one of the most lethal malignant tumors for which there is no effective treatment. There are an increasing number of studies on herbal medicine for treating malignant tumors, and the classic botanical medicine Digitalis and its active ingredients for treating heart failure and arrhythmias have been revealed to have significant antitumor efficacy against a wide range of malignant tumors. However, the main components of Digitalis and the molecular mechanisms of its anti-ATC effects have not been extensively studied. Here, we screened the main components and core targets of Digitalis and verified the relationship between the active components and targets through network pharmacology, molecular docking, and experimental validation. These experiments showed that the active ingredients of Digitalis inhibit ATC cell activity and lead to ATC cell death through the apoptotic pathway.
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Affiliation(s)
- Lei Zhu
- Suzhou
Medical College of Soochow University, 215123 Suzhou, Jiangsu, China
- Department
of Head and Neck Surgery, the Fifth Hospital Affiliated to Wenzhou
Medical University, Lishui Central Hospital, 323020 Lishui City, Zhejiang Province, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Ruimin Liang
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Yawen Guo
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Yefeng Cai
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Department
of Thyroid Surgery, The First Affiliated
Hospital of Wenzhou Medical University, 325015 Wenzhou City, Zhejiang Province, China
| | - Fahuan Song
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Yiqun Hu
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Yunye Liu
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Minghua Ge
- Suzhou
Medical College of Soochow University, 215123 Suzhou, Jiangsu, China
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
| | - Guowan Zheng
- Otolaryngology
& Head and Neck Center, Cancer Center, Department of Head and
Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated
People’s Hospital, Hangzhou Medical
College, 310014 Hangzhou, Zhejiang, China
- Key
Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
- Clinical
Research Center for Cancer of Zhejiang Province, 310014 Hangzhou, Zhejiang, China
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Pavlidis ET, Galanis IN, Pavlidis TE. Update on current diagnosis and management of anaplastic thyroid carcinoma. World J Clin Oncol 2023; 14:570-583. [PMID: 38179406 PMCID: PMC10762533 DOI: 10.5306/wjco.v14.i12.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 12/22/2023] Open
Abstract
Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS. Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioannis N Galanis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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