The potential role of neoadjuvant treatment in thyroid cancers in the era of kinase inhibitors: a narrative review

Abstract

Aim: To analyse the literature on the potential role of kinase inhibitors (KI) as neoadjuvant treatment (NAT) in all thyroid cancers (TC).

Materials and methods: Online databases were systematically examined, including MEDLINE (via PubMed) Embase, ISI Web of Science, Google Scholar, and Scopus. As many papers were published before the classification of TC was revised, our search was conducted as follows: NAT in TC, NAT in papillary thyroid cancer (PTC), NAT in follicular thyroid cancer (FTC), NAT in anaplastic thyroid cancer (ATC), and NAT in medullary thyroid cancer (MTC).

Results: The search revealed 21 single case reports and three small series on NAT in TC. Overall, 32 cases were found: 24 follicular cell derived cancers (FCDC) of which nine were ATC, eight were MTC. We also found four major retrospective series, in two of which the cohort was divided and analysed into different groups according to the kind of treatment. In these four series, NAT was performed in in a total of 99 patients (32 FCDC, 60 ATC, and 7 MTC).

Conclusions: While awaiting large-scale clinical trials, the literature highlights that NAT may be an option for locally advanced TC (and above all ATC) when surgery may be too destructive or when the tumour is inoperable. The use of NAT should be discussed with the patient. An R0 or at least an R1 should be the goal of NAT, and the molecular profile should be performed as rapidly as possible.

Keywords: Immune check-point inhibitors; Kinase inhibitors; Neoadjuvant treatment; Thyroid cancer.