page_title: Anaplastic thyroid cancer
section_title: Management
hierarchical_section_title: Anaplastic thyroid cancer / Management
caption_attribution_description: English: An anaplastic thyroid carcinoma cell (ARO) adhered to glass surface. Picture taken by a Scanning electron microscope (SEM), University of Crete, Heraklion, Greece. Ελληνικά: Καρκινικό κύτταρο θυρεοειδούς (ARO) προσκολλημένο σε επιφάνεια γυαλιού. Η φωτογραφία τραβήχτηκε με ηλεκτρονικό μικροσκόπιο σάρωσης, Πανεπιστήμιο Κρήτης, Ηράκλειο, Ελλάδα. English: Scanning electron microscopy image of a thyroid tumor cell adhered to glass surface.
context_page_description: Anaplastic thyroid cancer, also known as anaplastic thyroid carcinoma, is an aggressive form of thyroid cancer characterized by uncontrolled growth of cells in the thyroid gland. This form of cancer generally carries a very poor prognosis due to its aggressive behavior and resistance to cancer treatments. The cells of anaplastic thyroid cancer are highly abnormal and usually no longer resemble the original thyroid cells and have poor differentiation.
  ATC is an uncommon form of thyroid cancer only accounting for 1-2% of cases, but due to its high mortality, is responsible for 20-50% of deaths from thyroid cancer. The median survival time after diagnosis is three to six months. It occurs more commonly in women than in men and is seen most commonly in people ages 40 to 70.
context_section_description: ATC is considered an emergency cancer diagnosis since it poses a high risk of blocking the airway and/or esophagus due to its rapid growth in the neck, either of which can quickly cause a person's death by asphyxiation, if not immediately corrected. 
  Unlike its differentiated counterparts, anaplastic thyroid cancer is highly unlikely to be curable either by surgery or by any other treatment modality, and is in fact usually unresectable due to its high propensity for invading surrounding tissues. A multidisciplinary team including an endocrine pathologist, head and neck surgeon, medical oncologist, radiation oncologist, endocrinologist, and a palliative care physician is essential for optimal management. Palliative treatment consists of radiation therapy usually combined with chemotherapy.
  The use of tracheostomy as part of supportive care for ATC is controversial.
  Medications, such as fosbretabulin (a type of combretastatin), bortezomib and TNF-Related Apoptosis Induced Ligand (TRAIL), are, however, under investigation in vitro and in human clinical studies. Based on encouraging Phase I and II clinical trial results with fosbretabulin, a type of medication that selectively destroys tumor blood vessels, clinical trials have been evaluating whether the medication can extend the survival of patients with ATC.
  With the advent of molecular testing and next-generation sequencing, BRAF and MEK inhibitors are playing an increasing role in the management of patients with anaplastic thyroid cancer harboring such mutations. The combination of dabrafenib and trametinib has shown significant increases in overall survival and has been approved by the FDA. Another similar combination is vemurafenib and cobimetinib. 
  Immunotherapy is also starting to play an important role in anaplastic thyroid cancer management with several ongoing clinical trials demonstrating promising effects. Specific drugs being tested are atezolizumab, pembrolizumab, and spartalizumab, amongst others.
  Combinatorial therapy that is molecular-based may lead to significant tumor regression, potentially making patients amenable to curative surgery.
caption: Anaplastic thyroid carcinoma cells
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