Anaplastic outcomes.

Top Line: Does the addition of pazopanib to radiation and paclitaxel improve treatment outcomes for anaplastic thyroid carcinoma?

The Study: Anaplastic thyroid carcinoma is a rare but highly aggressive form of thyroid cancer that is rarely resectable and often managed with radiation and systemic therapy. However, there is limited prospective data to guide the best combination of therapy for ATC. RTOG 0912 was a randomized phase 2 trial of 71 patients receiving definitive chemoradiation for ATC. They were all treated with 2-3 cycles of paclitaxel and concurrent paclitaxel and RT consisting of 66 Gy in 33 fractions. They were randomized to receive either pazopanib or placebo along with induction and concurrent paclitaxel. Pazopanib is a small molecule kinase inhibitor that has been investigated in advanced differentiated thyroid cancer, so the hope was it would improve response to ATC. It didn't. There was no difference in median survival with or without pazopanib (5.7 v 7.3 months). The rate of OS at 1 year was 29% in the standard arm and 37% in the pazopanib arm. Pazopanib did not appear to significantly increase toxicity as the most common toxicity events were radiation-related (dysphagia and dermatitis). Of note, RTOG 0912 is one of the largest randomized trials ever for ATC. Unfortunately, it failed to move the needle in treatment outcomes.

TBL: The addition of pazopanib to radiation and paclitaxel does not improve survival for patients with ATC. | Sherman, Lancet Oncol 2022