Anaplastic thyroid cancer
ICD-10 C73 · ICD-11 2D10.3

Treatment of Anaplastic Thyroid Cancer: Unresectable Stage IVB–IVC Without BRAF V600E Mutation

This protocol addresses anaplastic thyroid cancer (ATC) in patients with unresectable stage IVB or stage IVC (metastatic) disease in whom BRAF V600E mutation testing returns negative — a subgroup for whom targeted BRAF/MEK inhibitor strategies are not applicable.

Clinical Scenario
Unresectable stage IVB or stage IVC (metastatic) ATC; BRAF V600E mutation absent. Surgical resection is not feasible. The absence of BRAF V600E mutation determines the treatment pathway, and aggressive systemic intervention is needed.
Treatment Approach
For patients with unresectable or advanced ATC wishing aggressive therapy, early initiation of cytotoxic bridging chemotherapy is recommended — a regimen centred on a taxane and/or an anthracycline, with or without a platinum agent. In patients with a low burden of metastatic disease, radiation therapy with concurrent chemotherapy may also be considered to maintain the airway. The complete regimen, individualized sequencing, and full clinical algorithm are available in the structured protocol.
Clinical Goals
Transient disease regression Maintenance of airway patency
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1089/thy.2020.0944

  1. Among ATC patients with unresectable or advanced disease wishing aggressive therapy, we suggest early initiation of cytotoxic chemotherapy as an initial and potentially bridging approach until mutational interrogation results and/or mutationally specified therapies might be available, and if appropriate.
  2. In metastatic ATC patients lacking other therapeutic options including clinical trials, we suggest cytotoxic chemotherapy including a taxane and/or an anthracycline or taxane with or without cis- or carbo-platin.
  3. In BRAF nonmutated patients, radiation therapy with concurrent chemotherapy should be considered in an effort to maintain the airway in patients with low burden of metastatic disease.
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