Neoadjuvant Combination Therapy with Tyrosine Kinase and Immune Checkpoint Inhibitors in Anaplastic Thyroid Cancer: A Single-Center, Real-World Experience.

[BACKGROUND] Most patients with anaplastic thyroid carcinoma (ATC) present with surgically unresectable disease. The use of combined kinase inhibitors and immunotherapy in the neoadjuvant setting for ATC remains relatively unexplored.

[METHODS] The authors conducted a single-center, retrospective case study assessing combination neoadjuvant therapy for patients with stages IVb and IVc ATC. The primary outcomes comprised the rate of conversion to surgery, changes in tumor size and surgical morbidity parameters, as well as recurrence-free survival and overall survival.

[RESULTS] Of the 27 ATC patients treated with combination kinase inhibitors and immunotherapy, 11 (40.7%) achieved R0/R1 surgical resection. The median reduction in the largest tumor diameter was 54%. Mean surgical complexity scores decreased from baseline to surgery. According to the postoperative pathology, five patients achieved a complete response. Several major complications were observed, including one perioperative death. Neither median recurrence-free survival nor median overall survival were reached during a median follow-up period of 36 months.

[CONCLUSIONS] Neoadjuvant combination therapy followed by surgery enhances resectability and provides a potential curative option for patients with ATC. However, postoperative complications remain a significant concern and warrant careful attention.