In a single-institution retrospective cohort study reported in JAMA Oncology, Maniakas et al found that overall survival in anaplastic thyroid carcinoma has improved in recent years and identified treatment factors associated with this improvement.
As stated by the investigators, “Anaplastic thyroid carcinoma historically has a 4-month median overall survival from time of diagnosis, with disease-specific mortality approaching 100%. The association between recent major advancements in treatment and overall survival has yet to be evaluated.”
The study included 479 consecutive patients with pathologically confirmed anaplastic thyroid carcinoma seen at The University of Texas MD Anderson Cancer Center from January 2000 to October 2019. Patients were divided into three groups according to date of presentation: 2000 to 2013 (n = 227), 2014 to 2016 (n = 100), and 2017 to 2019 (n = 152). Overall survival was compared among different treatment eras and different therapies.
Overall, 11% of patients had stage IVA, 36% stage IVB, and 53% stage IVC disease at presentation.
Significantly more patients received targeted therapy in the 2017–2019 group vs the 2000–2013 and 2014–2016 groups (61% vs 9% and 43%, overall P < .001) and significantly more patients in the 2017–2019 group received immunotherapy (47% vs 1% and 18%, overall P < .001).
The median overall survival of the entire cohort was 0.79 years (9.5 months), with a range of 0.01 to 16.63 years.
Overall survival at 1 year was 35% in the 2000–2013 group, 47% in the 2014–2016 group, and 59% in the 2017–2019 group. Overall survival at 2 years was 18%, 25%, and 42% (P < .001). Adjusted hazard ratios (HRs) were 0.77 (P = .06) for 2014–2016 vs 2000–2013 and 0.50 (P < .001) for 2017–2019 vs 2000–2013.
According to clinical stage at presentation, overall survival rates at 2 years in the respective eras were: 36%, 78%, and 63% for stage IVA; 24%, 27%, and 44% for stage IVB, and 9%, 18%, and 37% for stage IVC (overall P < .001).
Additional factors associated with improved overall survival included use of targeted therapy (HR = 0.49, P < .001), addition of immunotherapy to targeted therapy (HR = 0.58, P = .03), and surgery following neoadjuvant BRAF-directed therapy (HR = 0.29, P = .02).
The investigators concluded, “In this large single-institution cohort study spanning nearly 20 years, changes in patient management appear to be associated with significant increase in survival. The era of untreatable anaplastic thyroid carcinoma is progressively being replaced by molecular-based personalized therapies, with integration of multidisciplinary therapies including surgery and radiation therapy.”
Maria E. Cabanillas, MD, of the Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.