甲状腺未分化癌诊疗指南总结与靶向治疗研究放疗科课件

甲状腺未分化癌诊疗

现状及进展甲状腺未分化癌诊疗

现状及进展1AmericanThyroidAssociationGuidelinesforManagementofPatientswithAnaplasticThyroidCancer2012AmericanThyroidAssociationG2ATAG2012指南ATAG2012指南3ATAG2012指南ATAG2012指南4ATAG2012指南ATAG2012指南5ATAG2012指南辅助及增敏化疗方案ATAG2012指南辅助及增敏化疗方案6ATAG2012指南进展期化疗方案ATAG2012指南进展期化疗方案7ATAG2012指南转移情况的文献汇总ATAG2012指南转移情况的文献汇总82017NCCN指南V2术前完整评估分期情况后MDT讨论诊疗方案2017NCCN指南V2术前完整评估分期情况后MDT讨92017NCCN指南V22017NCCN指南V210AJCC分期标准AJCC分期标准112017NCCN指南推荐

化疗方案2017NCCN指南推荐

化疗方案12文献总结的治疗流程CriticalReviewsinOncology/Hematology86(2013)290–301与NCCN指南相同文献总结的治疗流程CriticalReviewsinO13放疗范围瘤床区及高危区域高剂量，淋巴结区域低剂量指南推荐IMRT放疗CriticalReviewsinOncology/Hematology86(2013)290–301放疗范围瘤床区及高危区域高剂量，淋巴结区域低剂量Critic14术后治疗方案的研究情况CriticalReviewsinOncology/Hematology86(2013)290–301术后治疗方案的研究情况CriticalReviewsin15CriticalReviewsinOncology/Hematology86(2013)290–301转归研究情况CriticalReviewsinOncology/H16CriticalReviewsinOncology/Hematology86(2013)290–301转归研究情况CriticalReviewsinOncology/H17CriticalReviewsinOncology/Hematology86(2013)290–301分化混杂ATC的研究报道结果CriticalReviewsinOncology/H18ClinicalReview

AnaplasticThyroidCarcinoma:TreatmentintheAgeofMolecularTargetedTherapyTheUniversityofTexasMDAndersonCancerCenter,Houston,TX

JournalofOncologyPractice

12,no.

6(June2016)511-518.ClinicalReview

AnaplasticThy19甲状腺未分化癌最常见的十种基因突变

JournalofOncologyPractice

12,no.

6(June2016)511-518.甲状腺未分化癌最常见的十种基因突变

JournalofO20Curativeintenttreatmentismultimodalandconsistsofsurgery(R0orR1resection)andexternalbeamradiationtherapywithradiosensitizingchemotherapy此案例也未切除对策甲状腺

JournalofOncologyPractice

12,no.

6(June2016)511-518.Curativeintenttreatmentism21Commonchemotherapyregi-

mensusedforradiosensitizationinanaplasticthyroidcarcinoma

JournalofOncologyPractice

12,no.

6(June2016)511-518.Commonchemotherapyregi-

men22NOVELTHERAPIESMoleculartargetedtherapytrialsinanaplasticthyroidcarcinomahavebeenconductedunderthebasketprotocoldesignandhavebeenlargelydirectedattargettingBRAFmutations.Othermutationspecifictrials,suchasthosethattargetPIK3CA,HRAS,andALK,arealsoavailableforpatientswithanaplasticthyroidcarcinoma,butthesemutationsareevenrarerthanBRAFmutationsinanaplasticthyroidcarcinoma(13%,4%,and1.5%,respectively).

JournalofOncologyPractice

12,no.

6(June2016)511-518.NOVELTHERAPIESMoleculartarge23BRAF-DirectedTherapiesTwobaskettrialshavecompletedenroll-ment一项报道了结果：7例患者使用单药vemurafenib；1例CR，1例PR，4例进展，1例不能评估另一项在入组中：NCT02091141Dabrafenib联合trametinib也在入组：NCT02034110

JournalofOncologyPractice

12,no.

6(June2016)511-518.BRAF-DirectedTherapiesTwobas24mTORInhibitors突变率：30%to35%AphaseIItrialusingeverolimusib入组了5例：1例近CR，1例SD，3例进展该例近CR患者具有TSC2突变，并稳定了18个月

JournalofOncologyPractice

12,no.

6(June2016)511-518.mTORInhibitors突变率：30%to35%25MultikinaseInhibitorssorafenib：1项研究入组10例，无治疗反应；另两项6例患者的研究，仍无治疗反应Pazopanib：single-arm,phaseIIstudy，无治疗反应Lenvatinib：phaseIIstudy，入组11例，3例PR，7例SD，1例PD；NCT02657369在开展中LenvatinibiscurrentlyapprovedfortreatmentofdifferentiatedthyroidcancerintheUnitedStates,butisapprovedforallsubtypesofthyroidcancerinJapan.

JournalofOncologyPractice

12,no.

6(June2016)511-518.MultikinaseInhibitorssorafen26MiscellaneousTargetedTherapiesCrolibulin：AphaseIandIIstudyevaluatingcrolibulinandcisplatin，16例，1例PR，1例CR达1年，II期未能完成，因入组太慢Efatutazone：I期，15例患者，1例PR。NCT02152137，在研中，II期，联合紫衫类

JournalofOncologyPractice

12,no.

6(June2016)511-518.MiscellaneousTargetedTherapi27ImmunotherapyPD-L1：无任何研究开展，仅有报道有表达

JournalofOncologyPractice

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6(June2016)511-518.ImmunotherapyPD-L1：无任何研究开展，仅有报28MolinaroE,RomeiC,BiaginiA,etal.Anaplasticthyroidcarcinoma:fromclinicopathologytogeneticsandadvancedtherapies[J].NatureReviewsEndocrinology,2017.UniversityHospitalofPisa.MolinaroE,RomeiC,Biagin29NatureReviewsEndocrinology,2017.NatureReviewsEndocrinology,30NatureReviewsEndocrinology,2017.NatureReviewsEndocrinology,31NatureReviewsEndocrinology,2017.NatureReviewsEndocrinology,32Distributionofoncogenicalterationsinanaplasticthyroidcarcinoma.NatureReviewsEndocrinology,2017.Distributionofoncogenicalte33Imatinib：治疗后复发，II期研究，400mgorallytwicedaily，treatmentresponseswereassessedevery8

weeks，6-monthprogression-freesurvival(PFS)was36%andthe6-monthOSwas45%Pazopanib：II期，16例，无反应；另一项入组中，October

2018结束Vemurafenib：twice-dailyoraldoseof960mg，1例15岁患者效果显著Everolimus：single-armphase

IItrial，6/40例ATC，PFSwas10

weeks(95%

CI4.8–16.0)andOSwas13

weeks(95%

CI7.4–18.6)inpatientswithATCNatureReviewsEndocrinology,2017.Imatinib：治疗后复发，II期研究，400mgo34Gefitinib:II期研究，250mgofgefitinibdaily，32%缩小但均不足PR，1/5例ATC稳定SD达12个月。Axitinib：II期研究，30%responserate,andwithstablediseaselasting>16

weeksin38%ofpatientsSunitinib：II期研究，overallmedianPFSof241

days，未报道治疗反应率Sorafenib：3项II期研究，9例有反应但不足PR；1项多种II期，20例，2例PR（10个月，27个月），5例SDNatureReviewsEndocrinology,2017.Gefitinib:II期研究，250mgofgef35Lenvatinib：日本II期，11/43例ATC，3例相比安慰剂OS获益；II其，17例，反应率24%；II其，HOPE研究，入组至2018-7；另一项II期，2018-7月入组结束；SELECT，比照安慰剂有3.6个月OS延长，反应率64.8%CombretastatinA4phosphate：II/III期，80/180ATC，提高去年OS达3倍；II期，联合化疗，1年OS23%；另一项III期开展中NatureReviewsEndocrinology,2017.Lenvatinib：日本II期，11/43例ATC，3例相36Croli