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Anaplastic Thyroid Cancer ATA 2021

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18 • Clinical Trials are strongly recommended if available • Best Supportive Care/Hospice option can be elected at any point IVA Other tumor genetics? e.g., ALK, NTRK, RET fusions BRAF V600E mut present? IVB Surgery Resectable? Y N N N Y Y Encourage definitive- intention therapy (because of potential for long-term survival for IVA patients) Rapid BRAF assessment (IHC, molecular), parallel Comprehensive genetic testing* • Goal: R0/R1 resection • Avoid debulking • Avoid laryngectomy generally preferred else Dabrafenib + Trametinib Treatment * Cytotoxic chemotherapy may be started as a 'bridge' while awaiting genomic information or while awaiting targeted therapy (e.g. dabrafenib and trametinib). Dashed arrows depict circumstances where competing therapeutic options may be of consideration. Figure 1. Initial Treatment of Stages IVA and IVB

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