Neoadjuvant treatment of differentiated thyroid cancer—case report

Introduction

Neoadjuvant treatment of advanced cancer is well accepted for anaplastic thyroid cancer. However, for differentiated thyroid cancer, neoadjuvant treatment guided by molecular testing is not described in the Swedish national guidelines and the American Thyroid Association guidelines recommend that such treatment should be included in a clinical trial. Here we present a patient with locally advanced papillary thyroid cancer, not considered operable at initial evaluation.

Methods

The patient was a 45-year-old male with no previous medical history and presented with increasing difficulties of swallowing.

Results

Initial imaging showed a locally advanced tumour originating from the thyroid with signs of oesophageal invasion. Imaging of the thorax showed suspicious lung metastases. Fine needle aspiration cytology showed papillary thyroid cancer. Core needle biopsy confirmed the diagnosis, and molecular testing showed a RET fusion. At flexible esophagoscopy, it was not possible to pass the tumour. The patient was dependent on a percutaneous gastrostomy for nutritional purposes. Due to local tumour invasion in combination with suspicious lung metastasis, it was decided to initiate neoadjuvant therapy with selperkatinib (Retsevmoâ). Due to inability of swallowing pills, a stent was introduced in the gastrostomy after dilatation.

A daily dose of selperkatinib 160 mg was initiated. Radiologic evaluation after 3 months showed local regression of the tumour although was still not considered operable. However, the patient was able to swallow pills, and the stent of the stoma was removed. It was decided to continue treatment with selperkatinib.

Discussion

Neoadjuvant targeted therapy may be appropriate in select cases also in differentated thyroid cancer.