Anti-PD-1 Immunotherapy Combined With Stereotactic Body Radiation Therapy and GM-CSF as Salvage Therapy in a PD-L1-Positive Patient With Refractory Metastatic Thyroid Hürthle Cell Carcinoma: A Case Report and Literature Review

Abstract

Thyroid Hürthle cell carcinoma, known as thyroid eosinophilic carcinoma, is a rare pathological type of differentiated thyroid cancer (DTC), representing 3-4% of all thyroid cancers. However, given the high risk of invasion and metastasis, thyroid Hürthle cell carcinoma has a relatively poor prognosis. Traditional treatment methods have limited effects on patients with metastatic thyroid cancers. Developing a valuable therapy for advanced thyroid carcinomas is an unfilled need, and immunotherapy could represent another choice for these tumors. We herein reported the case of a patient with recurrent advanced thyroid Hürthle cell cancer and positive programmed death-ligand 1 (PD-L1) expression, who suffered tumor progression after re-surgery, radiotherapy, and targeted therapy. It is encouraging that PD-1 inhibitors in combination with GM-CSF and stereotactic body irradiation (SBRT) on metastatic disease have a significant anti-tumor effect.

Immunotherapy Alone or in Combination with Stereotactic Body Radiotherapy in Advanced Lung Cancer: A Pooled Analysis of Randomized Clinical Trials

“…In addition, granulocyte-macrophage colony stimulating factor (GM-CSF) may be a potential factor in enhancing the efficacy of IT plus SBRT ( 21 , 22 ). In Ni's report, patients with advanced NSCLC who had failed first-line systemic therapy were treated with IT (sintilimab 200 mg, q3w) plus SBRT (24 Gy/3 Fractions) plus GM-CSF (125 μ g/m 2 d1-14, q3w).…”

Selenium, selenoproteins and cancer of the thyroid

“…Cytoplasmic granularity is due to the presence of numerous mitochondria [17]. Hurthle cell carcinoma is poorly avid to radioiodine and poorly responsive to chemotherapy and radiation [18]. Hurthle cell carcinoma is believed to be more aggressive than common follicular carcinoma [16].…”