2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

Abstract

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Since the guidelines for the management of ATC by the American Thyroid Association were first published in 2012, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, and researchers on published evidence relating to the diagnosis and management of ATC. Methods: The specific clinical questions and topics addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of the Task Force members (authors of the guideline). Relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. Results: The guidelines include the diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, targeted/systemic therapy, supportive care during active therapy), approaches to advanced/metastatic disease, palliative care options, surveillance and long-term monitoring, and ethical issues, including end of life. The guidelines include 31 recommendations and 16 good practice statements. Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of ATC. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with ATC.

The Role of Primary Cilia in Thyroid Cancer: From Basic Research to Clinical Applications

“…Drugs targeting PC have been assessed in patients with TC, and the findings from clinical trials show that doxorubicin, paclitaxel and docetaxel have modest antitumor activity in patients with advanced, nonmedullary TC ( 32 ). Carboplatin is recommended as a treatment for ATC in clinical practice guidelines in oncology ( 33 ).…”

Liquid Biopsy Can Accelerate the Genotyping of Anaplastic Thyroid Cancers

“…The potential for rapid disease progression and the advent of FDA-approved mutation-specific therapies create a mandate for rapid genotyping, at least in the case of BRAF V600E; the text of the 2021 guidelines acknowledges a potential role for cfDNA testing in this setting. The tone of the document, however, is guarded with respect to liquid biopsy: "at the present time, further work is required to create robust and clinical-grade assays that can use tumor DNA shed to patient blood for routine genotyping of ATC" (9). The current study is a step forward toward establishing a role for cfDNA liquid biopsy in the management of anaplastic thyroid cancer.…”

“…The 2021 American Thyroid Association guidelines for anaplastic thyroid cancer recommend that molecular profiling should be performed at the time of diagnosis (9). The potential for rapid disease progression and the advent of FDA-approved mutation-specific therapies create a mandate for rapid genotyping, at least in the case of BRAF V600E; the text of the 2021 guidelines acknowledges a potential role for cfDNA testing in this setting.…”

Novel Therapeutics in Radioactive Iodine-Resistant Thyroid Cancer

“…There have been major advances in the treatment of ATC over the last several years (31) as recent studies have demonstrated significant efficacy of BRAF/MEK inhibitors for BRAF-mutated ATC (9). Rapid and upfront genetic molecular testing, particularly for the BRAF V600E mutation, is mandatory.…”