ALK-mutated thyroid cancer

Abstract

At the moment, the standard of treatment in the Russian Federation for late stages of well-differentiated thyroid cancer (hereinafter referred to as WDTC) with a recorded radioiodine-resistant tumor status is the sequential administration of multikinase inhibitors: Sorafenib, Lenvatinib. Treatment protocols for subsequent lines have not been developed. The purpose of this article is to review the main molecular genetic features of WDTC and present the clinical observation of a patient with metastatic radioiodine-resistant follicular varient of papillary thyroid cancer (hereinafter referred to as PTC), which has progressed after previous lines of therapy. The patient’s tumor biological material was submitted for next-generation sequencing (NGS), which allows detection of all classes of molecular changes for a large number of genes. Due to the discovery of an ALK mutation and the lack of registered standards for subsequent treatment, ALK inhibitors were prescribed. This attempt to individualize therapy was successful: a partial response was registered during therapy and a significant clinical improvement in the patient’s general condition was noted. Therapy with ALK inhibitors continues to this day (46 months as of October 2023) and has a favorable toxicity profile. Thus, we can conclude that when the basic standards for the treatment of metastatic well-differentiated thyroid cancer have been exhausted, there is an individual selection of targeted therapy depending on the molecular genetic characteristics of the tumor process.