Anaplastic Thyroid Cancer and Lenvatinib

There are several types of thyroid cancer, papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer and anaplastic thyroid cancer. Anaplastic thyroid cancer (ATC) is a rare, aggressive form of thyroid cancer that constitutes about 1-2% of all thyroid cancer cases.

It typically affects older adults and has the characteristic of rapid growth to the other parts of the body.

Characteristics and Symptoms of Anaplastic Thyroid Cancer

Anaplastic thyroid cancer is one of the most aggressive cancer form among others thyroid cancers. It spreads early in the other parts of the body and take very few time to turn into advanced from localized cancer.

Common symptoms include a rapidly enlarging neck mass, difficulty swallowing or breathing, hoarseness, and sometimes pain.

Diagnosis processes of anaplastic thyroid cancer are physical examination, imaging studies (such as ultrasound, CT, or MRI), and biopsy. Fine-needle aspiration (FNA) is often used for the biopsy.

Molecular and Genetic Aspect

ATC may have the mutations in the TP53, BRAF, and RAS genes, among others. These mutations contribute to its aggressive nature and resistance to conventional treatments.

The histology of ATC cells is, they are usually large, pleomorphic, and can be spindle-shaped, giant, or squamoid. The histological appearance can vary, contributing to diagnostic challenges.

Treatment Options for Anaplastic Thyroid Cancer

Surgery: If the tumor is in the early stage and did not spread to other parts of the body then surgery is an option for ATC treatment.

Radiation Therapy: Post surgery, radiation therapy as a palliative treatment, can slow down the progression of cancer cells and control the symptoms.

Chemotherapy: With limited effectiveness, doctors use drugs like doxorubicin and cisplatin to perform chemotherapy in ATC treatment.

Targeted Therapy: In targeted therapy, drugs target specific genetic mutations and kills cancers cells or slow down their growth. In this case Drugs like lenvatinib and trametinib targets the BRAF mutation and have shown some promising results.

Immunotherapy: Immunotherapy to treat anaplastic thyroid cancer is still a hope. Researchers are trying to improve immunotherapy to treat this type thyroid cancer.

Prognosis and Management

Survival Rate: Anaplastic thyroid carcinoma is highly resistant to multimodality therapy, with a median survival of just 4 months. The 6-month survival rate is 35%, and the 2-year survival rate drops to 12%.

Several factors influence survival, including younger age, absence of metastases, smaller tumors, unilateral tumors, and limited local invasion. Metastases frequently spread to the lungs, brain, and bones.

Management: Due to its aggressiveness and poor prognosis, patients with anaplastic thyroid cancer often depend on palliative care to manage symptoms and maintain quality of life. Management includes quick staging and tissue sampling through biopsy or fine-needle aspiration, along with medical oncology care.

Research and Clinical Trials: Research is ongoing to understand the mechanism of anaplastic thyroid cancer better. They are also looking for the answer why anaplastic thyroid carcinoma spread fast. Hope is alive that soon the mechanism of that type of cancer will be disclosed clearly and more improved and specific targeted therapy will be available.

Lenvatinib to Treat Anaplastic Thyroid Cancer

Lenvatinib is proving to be a promising treatment for anaplastic thyroid cancer (ATC). In a phase 2 study, it showed manageable side effects and significant effectiveness against ATC tumors.

A retrospective study found lenvatinib to be an effective treatment that may improve prognosis for unresectable ATC. 4 out of 5 patients had treatment-related hypothyroidism, likely due to injury of the thyroid gland. Most adverse effects were manageable with dose modification.

A meta-analysis showed lenvatinib has a pooled partial response rate of 15%, disease control rate of 63%, and median progression-free survival and overall survival of about 3 months in ATC patients.

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