Durable response of anaplastic thyroid cancer to pembrolizumab combined with chemotherapy - A case report

Sep 22, 2026

Anaplastic thyroid cancer is an extremely aggressive malignancy with a median overall survival typically under one year. Options are scarce for patients lacking actionable driver mutations. This case report describes BRAF V600E wild-type, PD-L1-positive ATC (tumor proportion score 80%) with residual/relapsed disease after surgery and progression on multi-targeted tyrosine kinase inhibitor therapy. The patient then received pembrolizumab plus nabpaclitaxel and carboplatin, achieving a sustained near-complete response for over 30 months with manageable safety. The results support further evaluation of this triplet regimen, while acknowledging the need for validation, mechanistic clarification, and predictive biomarkers.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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ABSTRACT

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Introduction

HUMAN VACCINES & IMMUNOTHERAPEUTICS 2026, VOL. 22, NO. 1, 2608408 [https://doi.org/10.1080/21645515.2025.2608408](https://doi.org/10.1080/21645515.2025.2608408) CASE REPORT Durable response of anaplastic thyroid cancer to pembrolizumab combined with chemotherapy: A case report Zipei Chena, Qiongshan Chenb, Yihan Zhuanga, and Wen Lina aDepartment of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China; bDepartment of Nursing, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China ABSTRACT Anaplastic thyroid cancer is a notoriously aggressive malignancy with a dismal prognosis, typically associated with a median overall survival of less than one year. Therapeutic alternatives are particularly limited for patients without actionable driver mutations. Here, we report a case of BRAF V600E wild-type, PD-L1-positive (tumor proportion score of 80%) anaplastic thyroid cancer with residual/relapsed disease following surgery and subsequent progression on multi-targeted tyrosine kinase inhibitor therapy. The patient was thereafter treated with a combination of pembrolizumab, nabpaclitaxel and carboplatin, resulting in a sustained near-complete response lasting over 30 months, accompanied by a manageable safety profile. The favorable response in this case suggests that further evaluation of this triplet regimen could be considered for anaplastic thyroid cancer, though this remains a speculative premise requiring validation. Further studies are also needed to clarify the underlying mechanisms of this combination and to identify predictive biomarkers for patient selection. ARTICLE HISTORY Received 21 September 2025 Revised 8 December 2025 Accepted 18 December 2025 KEYWORDS Anaplastic thyroid cancer; pembrolizumab; immunotherapy; chemotherapy; case report Introduction Anaplastic thyroid cancer (ATC) is a rare but highly lethal type ofthyroid cancer. While it accounts for only 1–2% of all thyroid cancers, ATC contributes to more than half of thyroid cancer-related deaths. 1 Unlike differentiated thyroid cancer (DTC), which has a standardized treatment approach centered on radioiodine therapy with proven efficacy and well-documented adverse effects,2 ATC is resistant to radioiodine therapy due to the loss of sodium iodide symporter expression. Although there have been some improvements in survival for the last 2 decades, ATC still has a poor prognosis with a median overall survival (OS) less than 12 months.3 Chemotherapeutic drugs including taxanes, doxorubicin and platinum agents have been used in inoperable ATC but they rarely lead to responses and long-term survival.4–6 Approximately one-third of ATCs harbor a BRAF V600E mutation. In this subset of patients, the BRAF/MEK targeted combination therapy of dabrafenib and trametinib has been reported to achieve an objective response rate (ORR) of 56% and a median OS of 14.5 months.7 For patients who progress on BRAF/MEK targeted therapy or those without a BRAF V600E mutation, antiangiogenic agents have shown modest efficacy.8,9 Lenvatinib, for instance, is approved for ATC in Japan based on a phase II clinical trial in which it achieved an ORR of 24% and a median OS of 10.6 months in 17 ATC patients.10 Immunotherapy, particularly immune checkpoint inhibitors (ICIs), is currently undergoing clinical evaluation for ATC. A multicenter phase II study tested the PD-1 inhibitor spartalizumab on 42 ATC patients and showed that a small proportion of patients benefited from ICI monotherapy, with an ORR of 19% and a median OS of 5.9 months. 11 Combining chemotherapy with immunotherapy might be able to improve clinical efficacy by synergistically boosting immune response, modifying the immunosuppressive tumor microenvironment (TME), and overcoming resistance, potentially improving patient survival. 12 The NCCN guidelines recommend paclitaxel combined with carboplatin as a first-line regimen for ATC. However

FAQs

What treatment combination produced the sustained response in this case?

The patient received pembrolizumab combined with nabpaclitaxel and carboplatin, leading to a sustained near-complete response lasting over 30 months.

What were the key tumor biomarkers reported for the anaplastic thyroid cancer in the case?

The tumor was BRAF V600E wild-type and PD-L1-positive, with a tumor proportion score of 80%.

Why does the article discuss corticosteroid use alongside immunotherapy?

The text notes corticosteroids can be immunosuppressive and may compromise immunotherapy efficacy when used concurrently, motivating alternatives to steroid-requiring regimens.

Sep 22, 2026

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