Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA.
Indiana University Health, Indiana University, Indianapolis, Indiana, USA.
Oncologist. 2017 Oct;22(10):1149-1151. doi: 10.1634/theoncologist.2017-0096. Epub 2017 Aug 4.
Chemotherapy with or without radiation is the standard therapy for anaplastic thyroid cancer (ATC), although the response rate is not high and not durable. We describe a 62-year-old male who was diagnosed with ATC and initially treated with a thyroidectomy and lymph node dissection, followed by chemotherapy. Next generation sequencing was then performed to guide therapy and the tumor was found to have BRAF and programmed death-ligand 1 (PD-L1) positivity that was subsequently treated with vemurafenib and nivolumab. This led to substantial regression of tumor nodules. Genomic sequencing-based approaches to identify therapeutic targets has potential for improving outcomes. Currently, the patient continues to be in complete radiographic and clinical remission 20 months after beginning treatment with nivolumab.
Programmed death-1 (PD-1)/PD-L1 immunotherapy has shown evidence of durable responses in certain malignancies such as melanoma, lung cancer, and renal cell carcinoma.PD-L1 positive tumors promote autoimmunity against the tumor; therefore, PD-1/PD-L1 blockade may be beneficial.Molecular profiling could possibly result in improved targeted therapy for certain malignancies.
化疗联合或不联合放疗是间变性甲状腺癌（ATC）的标准治疗方法，尽管缓解率不高且不持久。我们描述了一名 62 岁男性，他被诊断为 ATC，最初接受了甲状腺切除术和淋巴结清扫术，然后进行了化疗。随后进行了下一代测序以指导治疗，发现肿瘤具有 BRAF 和程序性死亡配体 1（PD-L1）阳性，随后用维莫非尼和纳武利尤单抗治疗。这导致肿瘤结节明显消退。基于基因组测序的方法来识别治疗靶点有可能改善治疗效果。目前，患者在开始接受纳武利尤单抗治疗 20 个月后，继续完全缓解影像学和临床症状。
程序性死亡-1（PD-1）/PD-L1 免疫疗法已在某些恶性肿瘤中显示出持久缓解的证据，如黑色素瘤、肺癌和肾细胞癌。PD-L1 阳性肿瘤促进针对肿瘤的自身免疫；因此，PD-1/PD-L1 阻断可能有益。分子谱分析可能会导致某些恶性肿瘤的靶向治疗得到改善。
