ATA Guidelines Tools

8 Treatment Î The use of preemptive granulocyte colony-stimulating growth factor/ pegfilgrastim or weekly chemotherapy dosing regimens should be strongly considered when combining chemotherapy and radiotherapy in ATC so as to minimize the risks of treatment-related neutropenia and neutropenic infections. (S-L) Advanced Metastatic Disease (Stage IVC) Î Palliation of symptomatic and/or imminently threatening lesions should be given high priority in comparison to treatment with systemic therapy unless the primary threat to the patient is diffuse disease progression. (S-L) Î Since systemic therapy can result in transient, and occasionally more durable, disease regression or control in patients with advanced ATC and may improve survival in responders, it can reasonably be considered in patients with metastatic ATC of good performance status wishing an aggressive approach. (S-L) Î Patients with advanced or metastatic ATC wishing an aggressive approach should be encouraged to participate in clinical trials given the rarity of ATC, lack 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. (S-L) Î Combination or monotherapy including a taxane and/or an anthracycline could be considered in metastatic ATC if a suitable clinical trial is not otherwise available. (S-M) Î Since aggressive tumor-directed therapy may not be desired by or appropriate for all patients with metastatic ATC, consideration of best supportive care or hospice should also be prominently discussed as an alternative to systemic cancer-directed therapy. (S-L) Brain Metastases Î Patients considering therapy should have radiologic studies (MRI or CT scan) assessing the presence of brain metastases when ATC is diagnosed. Additional radiologic studies of the brain are indicated in the context of progressive disease and/or neurological abnormalities suggesting the development of a brain lesion or change in character or size of a known brain lesion. (S-M) Î Surgical removal of brain lesion(s) in selected patients and/or radiation therapy may result in better disease control. (W-L)

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