Optimization of the systemic therapy stage in the management of patients with anaplastic thyroid cancer: the experience of one center

Introduction. Anaplastic thyroid cancer is a rare and extremely aggressive disease characterized by unfavorable prognosis. Improvement of systemic therapy allowed to treat this pathology, however its efficacy is limited. Aim. To evaluate in real clinical practice efficacy of various systemic therapy regimens in patients with anaplastic thyroid cancer. Materials and methods. A retrospective study of patients who received systemic therapy between 2019 and 2024 in N. I. Pirogova Clinic of High Medical Technologies, Saint Petersburg State University was performed with assessment of progression-free survival, overall survival, and objective response rate. Results. Data on efficacy of 4 systemic therapy regimens were obtained: dabrafenib+ trametinib (n = 41; with BRAF gene mutation 41 (100 %) cases, without previous therapy 36 (87.8 %) cases), paclitaxel + carboplatin (n = 55; with BRAF gene mutation 14 (25.5 %) cases, without без previous therapy 44 (80 %) cases); doxorubicin (n = 17; with BRAF gene mutation 6 (35.3 %) cases, with previous therapy 17 (100 %) cases); pembrolizumab + lenvatinib (n = 18; with BRAF gene mutation 5 (27.8 %) cases, without previous therapy 11 (61.1 %) cases). Median progression-free survival in the dabrafenib + trametinib group was 163 days (95 % confidence interval 93–402), in the paclitaxel + carboplatin group 71 days, in the doxorubicin group 42 days, not reached in the pembrolizumab + lenvatinib group. Objective response rate for dabrafenib + trametinib therapy was 65.9 %, for paclitaxel + carboplatin 16.4 %, for doxorubicin 0 %, for pembrolizumab + lenvatinib 50 %. Median overall survival of patients with BRAF gene mutation was 299 days, of patients without it 156 days. One- and 2-year overall survival in these groups was 41.3 and 32.5 % versus 21.4 and 16.1 %, respectively. Conclusion. Immune therapy is a promising approach to treatment of anaplastic thyroid cancer but observation of these patients continues. Further search for new treatments for this pathology is necessary.