Survival in Response to Multimodal Therapy in Anaplastic Thyroid Cancer
Abstract Context Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. Objective To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival. Design MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic...
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Published in | The journal of clinical endocrinology and metabolism Vol. 102; no. 12; pp. 4506 - 4514 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Washington, DC
Endocrine Society
01.12.2017
Copyright Oxford University Press Oxford University Press |
Subjects | |
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Abstract | Abstract
Context
Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal.
Objective
To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival.
Design
MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999.
Patients
Forty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT.
Main Outcome Measure
Overall survival (OS) and progression-free survival determined by Kaplan-Meier method.
Results
Median OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy.
Conclusion
MMT appears to convey longer survival in ATC among patients with stage IVA/B disease.
Intensive multimodal therapy appears to convey improved survival among patients with stage IVA/B ATC and should be considered among those accepting of substantial therapy-related toxicities. |
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AbstractList | Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal.
To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival.
MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999.
Forty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT.
Overall survival (OS) and progression-free survival determined by Kaplan-Meier method.
Median OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy.
MMT appears to convey longer survival in ATC among patients with stage IVA/B disease. Abstract Context Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. Objective To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival. Design MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999. Patients Forty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT. Main Outcome Measure Overall survival (OS) and progression-free survival determined by Kaplan-Meier method. Results Median OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy. Conclusion MMT appears to convey longer survival in ATC among patients with stage IVA/B disease. Intensive multimodal therapy appears to convey improved survival among patients with stage IVA/B ATC and should be considered among those accepting of substantial therapy-related toxicities. Abstract Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. To determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival. MMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999. Forty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT. Overall survival (OS) and progression-free survival determined by Kaplan-Meier method. Median OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy. MMT appears to convey longer survival in ATC among patients with stage IVA/B disease. Intensive multimodal therapy appears to convey improved survival among patients with stage IVA/B ATC and should be considered among those accepting of substantial therapy-related toxicities. ContextHistorical outcomes in anaplastic thyroid cancer (ATC) have been dismal.ObjectiveTo determine whether an initial intensive multimodal therapy (MMT) is associated with improved ATC survival.DesignMMT was offered to all patients with newly diagnosed ATC treated at the Mayo Clinic from 2003 through 2015; MMT vs care with palliative intent (PI) was individualized considering clinical status and patient preferences. Outcomes were retrospectively analyzed by American Joint Committee on Cancer stage and treatments compared with patient cohort data from 1949 through 1999.PatientsForty-eight patients (60% male; median age, 62 years); 18 treated with PI, 30 with MMT.Main Outcome MeasureOverall survival (OS) and progression-free survival determined by Kaplan-Meier method.ResultsMedian OS and 1-year survival for the later cohort were 9 months [95% confidence interval (CI), 4 to 22 months] and 42% (95% CI, 28% to 56%) vs 3 months and 10% for the earlier cohort. Median OS was 21 months compared with 3.9 months in the pooled MMT vs PI groups for the later cohort [hazard ratio (HR), 0.32; P = 0.0006]. Among only patients in the later cohort who had stage IVB disease, median OS was 22.4 vs 4 months (HR, 0.12; 95% CI, 0.03 to 0.44; P = 0.0001), with 68% vs 0% alive at 1 year (MMT vs PI). Among patients with stage IVC cancer, OS did not differ by therapy.ConclusionMMT appears to convey longer survival in ATC among patients with stage IVA/B disease. |
Author | Morris, John Hay, Ian Kumar, Aditi Foote, Robert L Prasongsook, Naiyarat Grant, Clive Suman, Vera Garces, Yolanda Ryder, Mabel Molina, Julian Rivera, Michael McIver, Bryan Rubin, Joseph Chintakuntlawar, Ashish V Richards, Melanie Bible, Keith C Kasperbauer, Jan Wittich, Michelle A Neben Ma, Daniel Smallridge, Robert C Fatourechi, Vahab Thompson, Geoffrey Sebo, Thomas J Richardson, Ronald Jenkins, Sarah M |
AuthorAffiliation | 1Division of Medical Oncology, 2Division of Endocrinology, 3Department of Radiation Oncology, 4Department of Surgery, 5Department of Laboratory and Anatomical Pathology, 6Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; 7Division of Endocrinology, Mayo Clinic, Jacksonville, FL and the Endocrine Malignancies Disease Oriented Group, Mayo Clinic Cancer Center |
AuthorAffiliation_xml | – name: 1Division of Medical Oncology, 2Division of Endocrinology, 3Department of Radiation Oncology, 4Department of Surgery, 5Department of Laboratory and Anatomical Pathology, 6Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; 7Division of Endocrinology, Mayo Clinic, Jacksonville, FL and the Endocrine Malignancies Disease Oriented Group, Mayo Clinic Cancer Center |
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Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal.
Objective
To determine whether an initial intensive multimodal... Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. To determine whether an initial intensive multimodal therapy (MMT) is associated with... Abstract Historical outcomes in anaplastic thyroid cancer (ATC) have been dismal. To determine whether an initial intensive multimodal therapy (MMT) is... ContextHistorical outcomes in anaplastic thyroid cancer (ATC) have been dismal.ObjectiveTo determine whether an initial intensive multimodal therapy (MMT) is... |
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SubjectTerms | Adult Aged Aged, 80 and over Carcinoma - drug therapy Carcinoma - radiotherapy Carcinoma - therapy Chemoradiotherapy Cohort Studies Combined Modality Therapy Disease-Free Survival Female Health risk assessment Humans Kaplan-Meier Estimate Male Middle Aged Palliative Care Patients Retrospective Studies Survival Survival Analysis Therapeutic applications Thyroid cancer Thyroid Neoplasms - drug therapy Thyroid Neoplasms - radiotherapy Thyroid Neoplasms - therapy Thyroidectomy Toxicity Treatment Outcome |
Title | Survival in Response to Multimodal Therapy in Anaplastic Thyroid Cancer |
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