BRAF/MEK inhibition → surgery in anaplastic thyroid cancer

This sequence gives the BRAF/MEK inhibitor pair dabrafenib and trametinib, often with pembrolizumab, to shrink a BRAF-mutant anaplastic thyroid cancer before surgery, then removes what remains. Anaplastic thyroid cancer can double in weeks, whereas BRAF/MEK inhibition produces responses within days, buying time for definitive local therapy. The evidence is the anaplastic cohort of the phase 2 ROAR trial plus the MD Anderson institutional series, in which previously unresectable tumours became operable and responders lived far longer than the historical expectation; there is no randomised trial because the disease is so rare. Rapid BRAF testing at diagnosis is now standard so that eligible patients can start the pills immediately.