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Anaplastic thyroid cancer is the rare, fast-growing form that presents as a rapidly enlarging neck mass threatening the airway. Few patients lived more than a few months; combining BRAF-targeted drugs, immunotherapy, surgery and radiotherapy has lifted survival for the first time.
Anaplastic thyroid cancer is an undifferentiated carcinoma that usually arises from a pre-existing papillary or follicular cancer through the accumulation of TP53 and TERT mutations; about 40 percent carry BRAF V600E. It presents in older adults as a hard, rapidly growing neck mass with hoarseness, breathing or swallowing difficulty, and it does not take up iodine. Every case is staged IV. Rapid molecular testing is now urged at diagnosis because BRAF V600E tumours respond to dabrafenib plus trametinib, approved in 2018 on the ROAR basket trial, and neoadjuvant use has made some inoperable tumours resectable; pembrolizumab added to targeted therapy and chemoradiation for resectable disease are part of the multimodal approach that raised one-year survival at MD Anderson from about a fifth to over half. Airway management and early palliative care remain central.
One to two percent of thyroid cancers but a large share of thyroid cancer deaths; median survival in registry series before targeted treatment was historically about six months, meaning half of those patients lived longer, and every case is stage IV by definition.
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
Same organ: Acinic cell carcinoma of the salivary glands, Carcinoma ex pleomorphic adenoma, Multiple endocrine neoplasia type 1 (MEN1), Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma), Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer, Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Core biopsy with rapid BRAF testing, airway assessment, staging CT and PET; multidisciplinary planning within days.
Dabrafenib plus trametinib, with pembrolizumab in many centres; neoadjuvant use to make tumours resectable, then surgery and radiotherapy.
Surgery followed by chemoradiation (paclitaxel- or doxorubicin-based).
Chemoradiation or immunotherapy in trials; lenvatinib in some countries; palliative radiotherapy and airway support.
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The anaplastic thyroid cancer page's emphasis on speed, BRAF testing and neoadjuvant targeted therapy follows this guideline.
Neoadjuvant dabrafenib-trametinib to convert unresectable BRAF-mutant anaplastic thyroid cancer into operable disease is now a guideline-endorsed strategy.
Rapid BRAF testing is mandatory at diagnosis of anaplastic thyroid cancer, and BRAF-MEK inhibition, increasingly with pembrolizumab and as neoadjuvant therapy, is the standard for BRAF-mutant disease.
Query for this cancer: (TITLE:"Anaplastic thyroid cancer" OR ABSTRACT:"Anaplastic thyroid cancer" OR TITLE:"Anaplastic thyroid carcinoma" OR ABSTRACT:"Anaplastic thyroid carcinoma" OR TITLE:"ATC" OR ABSTRACT:"ATC" OR TITLE:"Undifferentiated thyroid carcinoma" OR ABSTRACT:"Undifferentiated thyroid carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Anaplastic thyroid cancer, not a curated reading list.
The first drug approval for this cancer.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
See all on the product pages:DabrafenibDoxorubicinLenvatinibPaclitaxel / nab-paclitaxelPembrolizumabTrametinib·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.