多模态治疗和酪氨酸激酶抑制剂治疗前后间变性甲状腺癌的结果：真实世界经验。

Multimodal treatments and outcomes for anaplastic thyroid cancer before and after tyrosine kinase inhibitor therapy: a real-world experience.

机构信息

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Eur J Endocrinol. 2021 May 6;184(6):837-845. doi: 10.1530/EJE-20-1482.

DOI:10.1530/EJE-20-1482

PMID:33852431

Abstract

BACKGROUND

Anaplastic thyroid cancer (ATC) has dismal prognosis and there is no effective treatment. We aimed to evaluate the efficacy of tyrosine kinase inhibitor (TKI) therapy in real-world clinic and to suggest the most effective treatment modality according to the combination of treatments.

METHODS

This retrospective study evaluated clinical outcomes and cause of death with multimodal treatments in patients with ATC at Samsung Medical Center.

RESULTS

A total of 120 patients received anti-cancer treatment for ATC. Seventy-seven (64.2%) patients underwent surgery, 64 (53.3%) received radiotherapy, 29 (24.2%) received cytotoxic chemotherapy, and 19 (15.8%) received TKI therapy. In the TKI therapy group, eight achieved partial response (three with lenvatinib and five with dabrafenib plus trametinib), and two patients with lenvatinib showed stable disease. Median progression-free survival (PFS) of the TKI therapy group was 2.7 months (range: 0.1-12.7) and their median overall survival (OS) was 12.4 months (range: 1.7-47.7). Patients who received surgery or radiotherapy for local control showed superior OS than those who did not. In a multivariate analysis, surgery, TKI therapy, younger age, and no distant metastasis were associated with favorable OS. The combination of surgery, radiotherapy, and TKI therapy (median OS: 34.3 months, 6-month survival rates: 77.8%) was the most effective. Compared to the era without TKI therapy, distant metastasis has recently become the major cause of death in ATC over airway problems.

CONCLUSIONS

Multimodality treatment including TKI therapy demonstrated prolonged survival with dabrafenib plus trametinib as the most effective therapeutic option demonstrated for BRAF mutant ATC patients.

摘要

背景

间变性甲状腺癌（ATC）预后极差，目前尚无有效治疗方法。我们旨在评估酪氨酸激酶抑制剂（TKI）治疗在真实临床环境中的疗效，并根据治疗联合情况提出最有效的治疗方式。

方法

本回顾性研究评估了在三星医疗中心接受多模式治疗的 ATC 患者的临床结局和死亡原因。

结果

共有 120 例患者接受了 ATC 的抗癌治疗。77 例（64.2%）患者接受了手术，64 例（53.3%）接受了放疗，29 例（24.2%）接受了细胞毒性化疗，19 例（15.8%）接受了 TKI 治疗。在 TKI 治疗组中，8 例达到部分缓解（3 例使用仑伐替尼，5 例使用达拉非尼加曲美替尼），2 例使用仑伐替尼的患者疾病稳定。TKI 治疗组的中位无进展生存期（PFS）为 2.7 个月（范围：0.1-12.7），中位总生存期（OS）为 12.4 个月（范围：1.7-47.7）。局部控制方面接受手术或放疗的患者 OS 优于未接受的患者。多变量分析显示，手术、TKI 治疗、年龄较小和无远处转移与良好的 OS 相关。手术、放疗和 TKI 治疗的联合（中位 OS：34.3 个月，6 个月生存率：77.8%）是最有效的。与没有 TKI 治疗的时代相比，远处转移最近已成为 ATC 患者死亡的主要原因，而非气道问题。