The first 60 days: Anaplastic thyroid cancer
Anaplastic thyroid cancer is the rare, fast-growing form that presents as a rapidly enlarging neck mass threatening the airway. It was almost uniformly fatal within months; combining BRAF-targeted drugs, immunotherapy, surgery and radiotherapy has lifted survival for the first time. Below, week by week, is what OnCo's record of Anaplastic thyroid cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Core biopsy with rapid BRAF testing, airway assessment, staging CT and PET; multidisciplinary planning within days.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Diagnosis.
- RadiologistNamed in the standard of care for: Diagnosis.
- SurgeonNamed in the standard of care for: BRAF V600E-mutant, BRAF wild-type, resectable.
- Medical oncologistNamed in the standard of care for: BRAF V600E-mutant, BRAF wild-type, resectable, Unresectable BRAF wild-type.
- Clinical oncologist (radiotherapy)Named in the standard of care for: BRAF V600E-mutant, BRAF wild-type, resectable, Unresectable BRAF wild-type.
- Palliative and supportive care teamNamed in the standard of care for: BRAF wild-type, resectable, Unresectable BRAF wild-type.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Surgery followed by chemoradiation (paclitaxel- or doxorubicin-based).
Chemoradiation or immunotherapy in trials; lenvatinib in some countries; palliative radiotherapy and airway support.
Dabrafenib plus trametinib, with pembrolizumab in many centres; neoadjuvant use to make tumours resectable, then surgery and radiotherapy.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example BRAF V600E, TP53 and TERT promoter mutations, PD-L1 expression, NTRK, RET and ALK fusions), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include BRAF V600E-mutant, RAS-mutant, Arising from differentiated thyroid cancer.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Diagnosis
- For my situation (diagnosis), which of the standard options do you recommend and why?Guideline options include: Core biopsy with rapid BRAF testing, airway assessment, staging CT and PET; multidisciplinary planning within days.
BRAF V600E-mutant
- For my situation (braf v600e-mutant), which of the standard options do you recommend and why?Guideline options include: Dabrafenib plus trametinib, with pembrolizumab in many centres; neoadjuvant use to make tumours resectable, then surgery and radiotherapy.
- Am I a candidate for Dabrafenib, Trametinib, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
BRAF wild-type, resectable
- For my situation (braf wild-type, resectable), which of the standard options do you recommend and why?Guideline options include: Surgery followed by chemoradiation (paclitaxel- or doxorubicin-based).
- Am I a candidate for Paclitaxel / nab-paclitaxel, Doxorubicin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Unresectable BRAF wild-type
- For my situation (unresectable braf wild-type), which of the standard options do you recommend and why?Guideline options include: Chemoradiation or immunotherapy in trials; lenvatinib in some countries; palliative radiotherapy and airway support.
- Am I a candidate for Lenvatinib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, Lenvatinib?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Most patients still die within a year”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “BRAF wild-type disease has no targeted option”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Anaplastic thyroid cancer: the full pageAnaplastic thyroid cancer is the rare, fast-growing form that presents as a rapidly enlarging neck mass threatening the airway. It was almost uniformly fatal within months; combining BRAF-targeted drugs, immunotherapy, surgery and radiotherapy has lifted survival for the first time.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.