Regression of Papillary Thyroid Cancer during Nivolumab for Renal Cell Cancer

Abstract

It is already known that papillary thyroid cancer arising in a background of Hashimoto thyroiditis shows increased programmed cell death-1 (PD-L1).• It is already known that metastases to the thyroid gland are uncommon, but frequently associated with renal cancer, especially when presenting as a fast growing nodule. Novel Insights• Our case strongly supports the evaluation of nivolumab and possibly other forms of immune therapy in the treatment of papillary thyroid carcinoma. • The presence of histiocyte aggregates on the site where the prior nodule had been observed supports the hypothesis of an immune-mediated tumor regression. AbstractImmune checkpoint inhibitors have been recently approved for cancer treatment. Nivolumab is a monoclonal antibody specific for programmed cell death-1 (PD-1) that modulates T-cell response. It was initially used for the treatment of ma-lignant melanoma and then approved in other cancers, such as non-small cell lung cancer and clear cell renal cell carcinoma (ccRCC). So far, the activity of nivolumab in patients with thyroid malignancies has been reported in a single case of anaplastic thyroid cancer. Here, we report the case of a patient with ccRCC who developed a papillary thyroid carci-Andrea Palermo and Andrea Napolitano contributed equally to this work.Palermo et al.noma (PTC) under first-line sunitinib treatment. During nivolumab, the second-line treatment for ccRCC, we unexpectedly observed a complete regression of PTC.

Single-cell transcriptomic analysis of the tumor ecosystems underlying initiation and progression of papillary thyroid carcinoma

“…and immunosuppressive (PD-1) signalings may bring hope to advanced BRAF -like-B patients who are potentially to be promising candidates for ICB. A few prior studies have reported partial or even complete regression of PTCs during the administration of PD-1 inhibitors 3 , 54 , 55 , indicating that at least a subset of patients would really benefit from ICB.…”

“…A few prior studies have reported partial or even complete regression of PTCs during the administration of PD-1 inhibitors 3,54,55 , indicating that at least a subset of patients would really benefit from ICB. The heterogeneity of stromal cells has been scarcely characterized in PTCs.…”

Reduced Tumor Size of Untreated Papillary Thyroid Carcinoma After Immune Checkpoint Inhibitor–Induced Thyroiditis

“…Ocampo et al 13 reported a reduction in the size of a lymph node positive for metastatic PTC after nivolumab treatment for hepatocellular carcinoma; however, information about the primary thyroid tumor was not provided. In another case, Palermo et al 14 described a patient with a 1.4-cm PTC that could no longer be identified by ultrasound 6 months after nivolumab treatment for renal cell carcinoma. Core biopsy of the thyroid parenchyma showed lymphocytes and histiocytes, consistent with a previous report of CPI-induced thyroiditis, 15 although no thyroid test results were provided.…”

“…Core biopsy of the thyroid parenchyma showed lymphocytes and histiocytes, consistent with a previous report of CPI-induced thyroiditis, 15 although no thyroid test results were provided. 14 Finally, Kotwal et al 16 reported a patient with CPI-induced thyroiditis enrolled in a study profiling of intrathyroidal lymphocytes who had a reduction in the size of a PTC. The patient was a 40-year-old woman treated with pembrolizumab for metastatic melanoma with a 1.4 × 0.9 × 0.9-cm PTC that decreased in size by ultrasound to 0.7 × 0.3 × 0.3 cm after 1 year of therapy, although the exact timing in relation to thyroid IrAE is unknown.…”