Anaplastic thyroid carcinoma and foscarnet use in a multitarget treatment documented by 18F-FDG PET/CT: A case report.
BACKGROUND
The case reported the rapid remission of disease recurrence achieved adding foscarnet, a DNA polymerase inhibitor that interacts with fibroblast growth factor 2, to low molecular weight heparin and sunitinib for the first time in a patient with an anaplastic thyroid cancer (ATC).


METHODS
A 65-year-old woman with a multinodular goiter referred for a rapid enlargement of a nodule. Histological examination revealed an ATC with a little area of papillary thyroid cancer (PTC). The patient was resistant to selective single-target treatment.


METHODS
Immunophenotyping and gene analyses found a significant increase in FGF2 and FGFR1 expression in the primary ATC area (FGF2 = 38.2 ± 6.2% in ATC vs 34.6 ± 6.0% in the differentiated area of PTC, P < 0.05; FGFR1: 41.7 ± 6.0% in ATC vs 34.4 ± 4.2% in PTC, P < 0.001) and in metastatic neck lymph nodes (P < 0.001 vs normal control tissues). Unlike conventional imaging, F-FDG PET/CT with PERCIST 1.0 criteria promptly and quantitatively detected disease recurrence and remission before and after multitarget therapy, combining anatomic, metabolic, and functional data.


METHODS
Foscarnet was administered given the positivity for FGF2, FGFR1 and FGFR4 in ATC. Low molecular wight heparin and Sunitinib were coadministere to limiti metastatic progression and on neck tumor masse, respectively.


RESULTS
The rationale for the clinical response to this innovative multitarget association with foscarnet is based on the histological and genetic finding that fibroblast growth factors and their receptor super-family are up-regulated in the primary anaplastic thyroid tumor and in the metastatic lymph node of our patient.


CONCLUSIONS
We propose that fibroblast growth factors and their receptor super-family play a key role as potential therapeutic targets in anaplastic thyroid cancer and the positive relevance of this suggestion for patient care, especially for an individualized management.
Department of Experimental Medicine Department of Internal Medicine and Clinical Specialities Department of Radiology, Anatomopathology and Oncology, Sapienza University of Rome, Rome Nuclear Medicine Unit, Department of Interventional Oncology, Azienda Ospedaliera Ospedale di Circolo di Busto Arsizio Varese, Busto Arsizio, Varese, Italy.
Elisa
E
Giannetta
Andrea M
AM
Isidori
Cosimo
C
Durante
Cira
C
Di Gioia
Flavia
F
Longo
Vincenzo
V
Tombolini
Nadia
N
Bulzonetti
Chiara
C
Graziadio
Riccardo
R
Pofi
Daniele
D
Gianfrilli
Antonella
A
Verrienti
Raffaella
R
Carletti
Sebastiano
S
Filetti
Andrea
A
Lenzi
Alberto
A
Baroli
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D017245:Foscarnet / Q000627:therapeutic use*; D006801:Humans; D000072078:Positron Emission Tomography Computed Tomography; D065646:Thyroid Carcinoma, Anaplastic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000998:Antiviral Agents; D019788:Fluorodeoxyglucose F18; D017245:Foscarnet