Advances in the Prognosis and Treatment of Medullary or Anaplastic Thyroid Cancer

Wieland Voigt, Karin Jordan, Hans-Joachim Schmoll
European Endocrinology, 2008;4(1):66-9
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Thyroid cancer accounts for approximately only 1% of all reported malignancies, but is the most common endocrine malignancy.1 It is of either follicular cell origin with well-differentiated papillary thyroid cancer and follicular thyroid cancer, poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), or of parafollicular C-cell origin with medullary thyroid cancer (MTC).2 ATC, one of the most aggressive malignancies in humans, accounts for approximately 2–5% and MTC for approximately 3–5% of all thyroid cancers.2 Owing to their distinct clinical and molecular characteristics, different multimodal treatment strategies have to be pursued.

While ATC is characterised by an almost fatal outcome, with survival that rarely exceeds one year regardless of the available therapy,1 unselected patients suffering from MTC have an overall 10-year survival of approximately 70% following primary surgery.3,4 However, little effective therapy has existed until recently for patients with unresectable MTC.4

Because of the rarity of the disease, large-scale prospective studies are scarce and thus, until now, most progress has come from retrospective analysis of treatment data collected over several decades. While surgery is the only curative treatment option in MTC,4 the exact role and sequence of surgery, radiation and chemotherapy in the multimodal treatment strategy in ATC is still a matter of debate.

Recent pre-clinical studies have identified a large battery of molecular alterations in thyroid cancer that provide the basis for the development of molecular targeted therapy for patients with progressive disease.2,4–6 Several novel compounds with promising activity in pre-clinical studies are currently being evaluated in small clinical trials, with promising results overall. However, the impact of these emerging therapies on the clinical course of the disease is yet to be defined.

This short article will summarise the data on multimodal treatment strategies in ATC and provide an overview of the new treatment options for MTC and ATC, with an emphasis on molecular targeted treatment.

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