16
Treatment
Recommendation 24
➤ In IVC ATC patients with high PD-L1 expression, checkpoint (PD-L1,
PD1) inhibitors can be considered first-line therapy in the absence of
other targetable alterations or as later line therapy, preferably in the
context of a clinical trial. (C-L)
Good Practice Statement 12
➤ Patients with BRAF wild-type (BRAF "negative" or unknown mutation
status) IVB unresectable or metastatic ATC wishing an aggressive
approach and not receiving chemoradiation should be encouraged to
participate in clinical trials given the rarity of ATC, the paucity of data
in support of improved survival or quality of life from any systemic
therapeutics, and the need to develop evidence-based safe and
effective therapeutic approaches in advanced ATC. (GPS)
Recommendation 25
➤ In metastatic ATC patients lacking other therapeutic options including
clinical trials, the ATA suggests cytotoxic chemotherapy including
a taxane and/or an anthracycline or taxane with or without cis- or
carbo-platin. (C-L)
Good Practice Statement 13
➤ Therapeutic decision-making in the setting of PD after initial therapy
regardless of somatic mutational status or therapy is very complex
and not easily defined by an algorithmic approach. In this setting,
care guided by an expert in ATC therapeutics is best pursued. (GPS)
Good Practice Statement 14
➤ As prognosis is dire in metastatic and progressive ATC, best
supportive care (hospice) should also be discussed as an option.
(GPS)
Recommendation 26
➤ In ATC patients considering therapy, the ATA recommends brain MRI
assessing the presence of brain metastases at time of diagnosis as a
part of initial staging and when symptoms otherwise prompt concern.
(S-L)
Recommendation 27
➤ In ATC patients with neurologic brain compressive symptoms or
signs, the ATA recommends dexamethasone (4–16 mg/day). (S-L)
Recommendation 28
➤ In ATC patients with brain metastases referral to neurosurgery/
radiation oncology should be made. (S-L)
