15
Recommendation 18
➤ The use of cytotoxic chemotherapy involving a taxane (paclitaxel or
docetaxel), administered with or without anthracyclines (doxorubicin)
or platin (cisplatin or carboplatin), is recommended in patients treated
with definitive-intention radiation. (S-L)
Systemic Therapeutic Approaches to Locally Advanced
Unresectable and/or Metastatic Disease
Recommendation 19
➤ Among ATC patients with unresectable or advanced disease wishing
aggressive therapy, the ATA suggests early initiation of cytotoxic
chemotherapy as an initial and potentially bridging approach until
mutational interrogation results and/or mutationally specified
therapies might be available, and if appropriate. (C-L)
Recommendation 20
➤ In BRAF
V600E
-mutated IVC and in unresectable IVB ATC patients
who decline radiation therapy, initiation of BRAF/MEK inhibitors
(dabrafenib plus trametinib) is recommended over other systemic
therapies if available. (S-L)
• Value Statement: The authors—including patient advocates—for this
recommendation placed a high value on available and emerging data indicating
the potential for profound benefit from using this approach in a setting where
little hope had previously existed, supporting the strong recommendation made in
the presence of low-quality evidence.
Recommendation 21
➤ In BRAF
V600E
-mutated unresectable stage IVB ATC in which radiation
therapy is feasible, chemoradiotherapy or neoadjuvant dabrafenib/
trametinib represents alternatives to initial therapy. (C-L)
Recommendation 22
➤ In BRAF non-mutated patients, radiation therapy with concurrent
chemotherapy should be considered in an effort to maintain the
airway in patients with low burden of metastatic disease. (S-L)
Recommendation 23
➤ In NTRK or RET fusion ATC patients with stage IVC disease, the
ATA suggests initiation of a TRK inhibitor (either larotrectinib or
entrectinib) or RET inhibitor (either selpercatinib or pralsetinib),
preferably in a clinical trial, if available. (C-VL)
