title: Thyroidectomy followed by fosbretabulin (CA4P) combination regimen appears to suggest improvement in patient survival in anaplastic thyroid cancer.
abstract: BACKGROUND
  Anaplastic thyroid cancer (ATC) is an aggressive neoplasm for which a paucity of data exist about the relative role of operative procedures in disease management.
  
  
  METHODS
  The FACT trial was a randomized, controlled phase 2/3 trial assessing the safety and efficacy of carboplatin/paclitaxel with CA4P (experimental arm) or without CA4P (control arm) in ATC, 2007-11. Patients were permitted to have had an operation before enrollment, which was stratified on the basis of exposure to operation. A subpopulation of patients who had a cancer-related operation (thyroidectomy) was compared with those who did not, and 1-year and median survival were estimated.
  
  
  RESULTS
  A total of 80 patients were enrolled; 55% had undergone a cancer-related operation, of whom 70% had near-total/total thyroidectomy. Baseline characteristics for operative and nonoperative patients were not substantially different. Median survival for patients who had cancer-related operation was 8.2 months in the CA4P arm versus 4.0 months in the control arm, resulting in a hazard ratio of 0.66 (P = .25) and a suggested associated reduction in risk of death of 35%. 1-year survival was 33.3% in the CA4P arm versus 7.7% in the control arm.
  
  
  CONCLUSIONS
  In this largest prospective study ever conducted in ATC, thyroidectomy followed by CA4P combination regimen showed a nonsignificant trend toward improvement in patient survival.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. Julie.sosa@yale.edu
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.forename: Jai
authors.initials: J
authors.lastname: Balkissoon
authors.forename: Shiao-ping
authors.initials: SP
authors.lastname: Lu
authors.forename: Peter
authors.initials: P
authors.lastname: Langecker
authors.forename: Rossella
authors.initials: R
authors.lastname: Elisei
authors.forename: Barbara
authors.initials: B
authors.lastname: Jarzab
authors.forename: C S
authors.initials: CS
authors.lastname: Bal
authors.forename: Shanthi
authors.initials: S
authors.lastname: Marur
authors.forename: Ann
authors.initials: A
authors.lastname: Gramza
authors.forename: Frank
authors.initials: F
authors.lastname: Ondrey
mesh_terms: D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013267:Stilbenes / Q000627:therapeutic use*; D015996:Survival Rate; D065646:Thyroid Carcinoma, Anaplastic; D013964:Thyroid Neoplasms / Q000401:mortality / Q000628:therapy*; D013965:Thyroidectomy
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D013267:Stilbenes; C058728:fosbretabulin