IMMUNOTHERAPY IN TREATMENT OF ANAPLASTIC THYROID CANCER: A CASE REPORT

Lenche Kostadinova; Deva Petrova; Marija Karakolevska Ilova

Lenche Kostadinova University Clinic of Radiotherapy and oncology in Skopje, Faculty of Medical Sciences, Goce Delcev University in Stip, North Macedonia
Deva Petrova Clinic of Radiotherapy and oncology inClinical Hospital Adzibadem Sistina, Faculty of Medical Sciences, Goce Delcev, University in Stip, North Macedonia
Marija Karakolevska Ilova Department of Radiotherapy and oncology General Hospital in Stip, Faculty of Medical Sciences, Goce Delcev University in Stip, North Macedonia

Abstract

This case report describes a 55-year-old woman with diagnosed anaplastic thyroid cancer (ATC). Initially, the patient was treated surgically, followed by rapid progression. After that radiation therapy was performed, and the patient immediately progresses again. It was decided that the patient should start chemotherapy while waiting for molecular tests due to the rapid growth of the cancer. After six cycles of chemotherapy in which the disease was stable progression occurred again immediately after discontinuation of chemotherapy. Molecular test shows PD-L1 positive patient with CPS score of 20% and she was put on immunotherapy with pembrolizumab. After 1 year of immunotherapy treatment, PET CT scan showed metabolic and morphological regression of tumor mass in the neck and cervical lymph nodes. The patient had a good quality of life with no side effects throughout the immunotherapy. In this case, we want to emphasize that immunotherapy can also be considered as choice of treatment in anaplastic thyroid carcinoma who represents carcinomas with high lethality rate.

Keywords: thyroid anaplastic carcinoma, immunotherapy, PD-L1, pembrolizumab.

References

1. de Ridder M, Nieveen van Dijkum E, Engelsman A, Kapiteijn E, Klümpen HJ, Rasch CR. Anaplastic thyroid carcinoma: a nationwide cohort study on incidence, treatment and survival in the Netherlands over 3 decades. European Journal of Endocrinology. 2020 Aug;183(2):203-9.
2. Rao SN, Smallridge RC. Anaplastic thyroid cancer: An update. Best Practice & Research Clinical Endocrinology & Metabolism. 2023 Jan 1;37(1):101678.
3. Wendler J, Kroiss M, Gast K, Kreissl MC, Allelein S, Lichtenauer U, Blaser R, Spitzweg C, Fassnacht M, Schott M, Führer D. Clinical presentation, treatment and outcome of anaplastic thyroid carcinoma: results of a multicenter study in Germany. European journal of endocrinology. 2016 Dec;175(6):521-9.
4. Wang C, Zhang Y. Current Application of Nanoparticle Drug Delivery Systems to the Treatment of Anaplastic Thyroid Carcinomas. International Journal of Nanomedicine. 2023 Dec 31:6037-58.
5. Maniakas A, Dadu R, Busaidy NL, Wang JR, Ferrarotto R, Lu C, Williams MD, Gunn GB, Hofmann MC, Cote G, Sperling J. Evaluation of overall survival in patients with anaplastic thyroid carcinoma, 2000-2019. JAMA oncology. 2020 Sep 1;6(9):1397-404.
6. Cabanillas ME, Dadu R, Iyer P, Wanland KB, Busaidy NL, Ying A, Gule-Monroe M, Wang JR, Zafereo M, Hofmann MC. Acquired secondary RAS mutation in BRAFV600E-mutated thyroid cancer patients treated with BRAF inhibitors. Thyroid. 2020 Sep 1;30(9):1288-96.
7. Wang, K., Zhang, Y., Xing, Y. et al. Current and future of immunotherapy for thyroid cancer based on bibliometrics and clinical trials. Discover Oncology. 2024 Feb 25;15(1):50.
8. Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, Campbell M, Dickson P, Duh QY, Ehya H, Goldner WS. Thyroid carcinoma, version 2.2022, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2022 Aug 1;20(8):925-51.
9. Eight Edition S, Edge S, Byrd D. AJCC cancer staging manual. AJCC cancer staging manual. 2017.
10. https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
11. Alsaab HO, Sau S, Alzhrani R, Tatiparti K, Bhise K, Kashaw SK, Iyer AK. PD-1 and PD-L1 checkpoint signaling inhibition for cancer immunotherapy: mechanism, combinations, and clinical outcome. Frontiers in pharmacology. 2017 Aug 23;8:561.
12. Topalian SL, Taube JM, Anders RA, Pardoll DM. Mechanism-driven biomarkers to guide immune checkpoint blockade in cancer therapy. Nature Reviews Cancer. 2016 May;16(5):275-87.
13. Simeone E, Grimaldi AM, Ascierto PA. Anti-PD1 and anti-PD-L1 in the treatment of metastatic melanoma. Melanoma Management. 2015 Feb 1;2(1):41-50.
14. Ma M, Lin B, Wang M, Liang X, Su L, Okose O, Lv W, Li J. Immunotherapy in anaplastic thyroid cancer. American Journal of Translational Research. 2020 Mar 15;12(3):974.
15. McDermott J, Jimeno A. Pembrolizumab: PD-1 inhibition as a therapeutic strategy in cancer. Drugs of today (Barcelona, Spain: 1998). 2015 Jan 1;51(1):7-20.
16. Goodman AM, Piccioni D, Kato S, Boichard A, Wang HY, Frampton G, Lippman SM, Connelly C, Fabrizio D, Miller V, Sicklick JK, Kurzrock R. Prevalence of PDL1 amplification and preliminary response to immune checkpoint blockade in solid tumors. JAMA Oncol. 2018;4:1237–1244. doi: 10.1001/jamaoncol.2018.1701.
17. Zaretsky JM, Garcia-Diaz A, Shin DS, Escuin-Ordinas H, Hugo W, Hu-Lieskovan S, Torrejon DY, Abril-Rodriguez G, Sandoval S, Barthly L, Saco J. Mutations associated with acquired resistance to PD-1 blockade in melanoma. New England Journal of Medicine. 2016 Sep 1;375(9):819-29.
18. Rotte A, Jin JY, Lemaire V. Mechanistic overview of immune checkpoints to support the rational design of their combinations in cancer immunotherapy. Annals of Oncology. 2018 Jan 1;29(1):71-83.