First-line chemo does not improve survival in anaplastic thyroid cancer

First-line treatment with carboplatin/paclitaxel (CP), with or without radiotherapy, is not associated with improvements in survival among patients with anaplastic thyroid cancer (ATC), as shown in a study.

“Prognosis of ATC remains poor. In the absence of immediately actionable molecular alterations, guidelines recommend multimodal therapy including radiotherapy and cytotoxic chemotherapy, but optimal regimens are not established,” the investigators said.

Some 158 patients with histologically confirmed ATC treated with first-line cytotoxic chemotherapy at seven German tertiary centres were included in this retrospective study. Of these, 97 received first-line CP, and 61 received other chemotherapy agents.

The investigators compared progression-free survival (PFS) and overall survival (OS) with Kaplan‒Meier and log-rank tests. They also identified risk factors using a Cox proportional hazard model.

No significant differences were observed in PFS (102 vs 89 days; log-rank p=0.23) and OS (278 vs 295 days; p=0.50) between CP and other regimens. Complete response occurred in 13 percent and 8 percent of patients, respectively (p=0.46).

Multivariable analyses revealed the following factors associated with increased mortality risk: age ≥65 years, lymph node metastasis, and distant metastasis. On the other hand, surgery correlated with a reduced risk of death. CP showed no significant association with improved OS.

Furthermore, the outcomes of second-line treatment did not differ for chemotherapy compared with kinase inhibition with or without immunotherapy.

“[The] outcomes depended on disease burden and resectability, underscoring the need for rapid molecular diagnostics. Chemotherapy may serve as a bridging strategy,” the investigators said.