Gui Lin, Liu Shaoyan, Zhang Ye, Shi Yuankai
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People's Republic of China.
Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Onco Targets Ther. 2021 Apr 20;14:2741-2746. doi: 10.2147/OTT.S305196. eCollection 2021.
Anaplastic thyroid carcinoma (ATC) is a rare and highly aggressive fatal tumor. Most ATC patients using traditional surgery or radio-chemotherapy have poor prognosis and experience recurrence in a very short time. There is no optimal therapy for ATC, and the median survival time is about 5 months. We report a 67-year-old ATC patient, who experienced rapid local recurrence after radical thyroidectomy. The resected tumor tissue was sent for immunohistochemistry analysis and targeted next-generation sequencing. The results indicated high PD-L1 expression, a tumor mutation burden of 0.48 muts/Mb, microsatellite stable, and somatic mutations of promoter, and . However, none of the mutations indicated corresponding target therapy. An immediate operation was unsuitable because of rapid recurrence after surgery. The patient was also not in a condition to tolerate chemotherapy. Based on the high expression of PD-L1, an optimum strategy was used, combining immunotherapeutic agent, sintilimab, with an anti-angiogenesis drug, anlotinib. The patient obtained remarkable tumor shrinkage and an 18.3-month-sustained remission period. This is an effective case of using immunotherapy and anti-angiogenesis agent in the first-line treatment of ATC. It demonstrates a feasible and novel therapeutic option for future treatment of ATC patients.
间变性甲状腺癌（ATC）是一种罕见且侵袭性极强的致命肿瘤。大多数接受传统手术或放化疗的ATC患者预后较差，且在极短时间内就会复发。目前尚无针对ATC的最佳治疗方法，其平均生存时间约为5个月。我们报告了一名67岁的ATC患者，该患者在甲状腺全切术后出现快速局部复发。将切除的肿瘤组织送去进行免疫组化分析和靶向二代测序。结果显示PD-L1高表达，肿瘤突变负荷为0.48个突变/Mb，微卫星稳定，以及启动子的体细胞突变。然而，这些突变均未提示相应的靶向治疗。由于术后快速复发，立即手术并不合适。该患者也无法耐受化疗。基于PD-L1的高表达，采用了一种优化策略，将免疫治疗药物信迪利单抗与抗血管生成药物安罗替尼联合使用。该患者肿瘤显著缩小，缓解期长达18.3个月。这是免疫治疗和抗血管生成药物用于ATC一线治疗的有效案例。它为未来ATC患者的治疗展示了一种可行且新颖的治疗选择。
