Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report
Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors. ATC is frequently diagnosed at advanced stages with unresectable disease and palliative care is often indicated. Recently, several patient-tailored therapies for ATC are emerging due to advances in molecular p...
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| Format: | Article |
| Language: | English |
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Bioscientifica
2023-01-01
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| Series: | European Thyroid Journal |
| Subjects: | |
| Online Access: | https://etj.bioscientifica.com/view/journals/etj/12/1/ETJ-22-0179.xml |
| _version_ | 1811177304142905344 |
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| author | Inês Damásio Joana Simões-Pereira Sara Donato Mariana Horta Branca Maria Cavaco Miguel Rito Pedro Gomes Valeriano Leite |
| author_facet | Inês Damásio Joana Simões-Pereira Sara Donato Mariana Horta Branca Maria Cavaco Miguel Rito Pedro Gomes Valeriano Leite |
| author_sort | Inês Damásio |
| collection | DOAJ |
| description | Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors. ATC is frequently diagnosed at advanced stages with unresectable disease and palliative care is often indicated. Recently, several patient-tailored therapies for ATC are emerging due to advances in molecular profiling of these tumors. Entrectinib is a potent oral selective inhibitor of neutrotrophic tropomyosin receptor kinase (NTRK), ROS1, and anaplastic lymphoma kinase fusions. The experience regarding ATC and other thyroid carcinomas, particularly in the neoadjuvant setting, is minimal.
Case report: We present a case of a 51-year-old female patient presenting with a bulky mass of the left thyroid lobe measuring 100 × 108 × 80 mm that was considered surgically unresectable. While waiting for next-generation sequence (NGS) profiling, lenvatinib was initiated. There was an initial clinical and imagiologic response; however, progression occurred after 12 weeks, and at this time NGS ident ified an ETV6-NTRK3 fusion and entrectinib was started. After 12 weeks, tumor diameters reduced to a minimum of 68×60×49 mm, and the patient underwent total thyroidectomy plus central lymphadenectomy. Histological diagnosis confirmed an ATC (pT4a R 2 N1a). Adjuvant radiotherapy (RT) (60 Grays) with weekly paclitaxel (45 mg/m2) was then administered followed by maintenance entrectinib 600 mg daily. Fluorodeoxyglucose positron emission tomography performed 3 months after completion of RT showed only non-specific uptake in the posterior wall of the hypopharynx and lar ynx, suggestive of inflammation.
Conclusion: We report the first case of an ATC with a dramatic response to neoadjuvant therapy with entrectinib, which enabled surgical resection of an ab initio unresectable tumor. |
| first_indexed | 2024-04-10T23:00:35Z |
| format | Article |
| id | doaj.art-ce4f4c55ac8a40e1926b81153d0bc38f |
| institution | Directory Open Access Journal |
| issn | 2235-0802 |
| language | English |
| last_indexed | 2024-04-10T23:00:35Z |
| publishDate | 2023-01-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | European Thyroid Journal |
| spelling | doaj.art-ce4f4c55ac8a40e1926b81153d0bc38f2023-01-14T01:46:03ZengBioscientificaEuropean Thyroid Journal2235-08022023-01-0112116https://doi.org/10.1530/ETJ-22-0179Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case reportInês Damásio0Joana Simões-Pereira1Sara Donato2Mariana Horta3Branca Maria Cavaco4Miguel Rito5Pedro Gomes6Valeriano Leite7Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalEndocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalEndocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalRadiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon PortugalMolecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalPathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalHead and Neck Surgery Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PortugalEndocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Nova Medical School, Lisbon, PortugalBackground: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors. ATC is frequently diagnosed at advanced stages with unresectable disease and palliative care is often indicated. Recently, several patient-tailored therapies for ATC are emerging due to advances in molecular profiling of these tumors. Entrectinib is a potent oral selective inhibitor of neutrotrophic tropomyosin receptor kinase (NTRK), ROS1, and anaplastic lymphoma kinase fusions. The experience regarding ATC and other thyroid carcinomas, particularly in the neoadjuvant setting, is minimal. Case report: We present a case of a 51-year-old female patient presenting with a bulky mass of the left thyroid lobe measuring 100 × 108 × 80 mm that was considered surgically unresectable. While waiting for next-generation sequence (NGS) profiling, lenvatinib was initiated. There was an initial clinical and imagiologic response; however, progression occurred after 12 weeks, and at this time NGS ident ified an ETV6-NTRK3 fusion and entrectinib was started. After 12 weeks, tumor diameters reduced to a minimum of 68×60×49 mm, and the patient underwent total thyroidectomy plus central lymphadenectomy. Histological diagnosis confirmed an ATC (pT4a R 2 N1a). Adjuvant radiotherapy (RT) (60 Grays) with weekly paclitaxel (45 mg/m2) was then administered followed by maintenance entrectinib 600 mg daily. Fluorodeoxyglucose positron emission tomography performed 3 months after completion of RT showed only non-specific uptake in the posterior wall of the hypopharynx and lar ynx, suggestive of inflammation. Conclusion: We report the first case of an ATC with a dramatic response to neoadjuvant therapy with entrectinib, which enabled surgical resection of an ab initio unresectable tumor.https://etj.bioscientifica.com/view/journals/etj/12/1/ETJ-22-0179.xmlanaplastic thyroid carcinomaentrectinibneoadjuvancyprecision medicine |
| spellingShingle | Inês Damásio Joana Simões-Pereira Sara Donato Mariana Horta Branca Maria Cavaco Miguel Rito Pedro Gomes Valeriano Leite Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report European Thyroid Journal anaplastic thyroid carcinoma entrectinib neoadjuvancy precision medicine |
| title | Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report |
| title_full | Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report |
| title_fullStr | Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report |
| title_full_unstemmed | Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report |
| title_short | Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report |
| title_sort | entrectinib in the neoadjuvant setting of anaplastic thyroid cancer a case report |
| topic | anaplastic thyroid carcinoma entrectinib neoadjuvancy precision medicine |
| url | https://etj.bioscientifica.com/view/journals/etj/12/1/ETJ-22-0179.xml |
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