Nearly Half of Patients with Anaplastic Thyroid Cancer May Be Amenable to Immunotherapy

Author:

Chern Beverley1,Pinto Diluka12,Lum Jeffrey Hy3ORCID,Parameswaran Rajeev145ORCID

Affiliation:

1. Division of Endocrine Surgery, National University Hospital Health System, Lower Kent Ridge Road, Singapore 119074, Singapore

2. Division of Surgery, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Colombo P.O. Box 6, Sri Lanka

3. Department of Pathology, National University Hospital, Singapore 119074, Singapore

4. Department of Surgery, Yong Loo Lin School of Medicine, Level 8, IE Kent Ridge Road, Singapore 119228, Singapore

5. NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore

Abstract

Importance: Poorly differentiated cancer (PDC) and anaplastic thyroid cancer (ATC) have an aggressive course of disease with limited treatment options. The expression of programmed cell death ligand-1 (PD-L1) has been used to determine the responses of many cancers to immunotherapy. The aim of the study was to investigate the expression of PD-L1 in a cohort of patients with PDC and ATC to assess their suitability for immunotherapy. Data, settings, and participants: This study is a retrospective cohort review of patients treated for PDC and ATC treated at a tertiary referral institution during the period 2000–2020. PD-L1 22C3 pharmDx qualitative immunohistochemistry was performed on formalin-fixed, paraffin-embedded (FFPE) specimens of tumours to detect the presence of the PD-L1 protein. Main outcome measures: The percentage of tumours that were positive for PD-L1 immunohistochemistry and the PD-L1 protein expression as measured by using the Tumour Proportion Score (TPS). Secondary outcomes studied were the associations between demographic, clinicopathological, treatment and disease outcomes and PD-L1 expression. Results: Nineteen patients (12F:7M) with a mean age of 65.4 (±14.3 SD) years were diagnosed with PDC in 4 (21%) and fifteen were diagnosed with ATC (79%) during the study period. Fifteen (79%) patients underwent some form of surgery, with R0 resection achieved in only three of the fifteen (20%) patients. Overall, PD-L1 expression was seen in seven of the fifteen (47%) of the patients with ATC, with no positivity seen in the patients with PDC. PD-L1 expression had no impact on treatment modality and positive expression was not significantly associated with stage of disease, metastasis, or survival. Conclusion: Nearly half of patients with ATC express PD-L1 and may be amenable to immunotherapy with pembrolizumab.

Publisher

MDPI AG

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