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case_images: Entire treatment process of the patient with poorly differentiated thyroid cancer.
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case_images: A 37-year-old male patient was admitted to a local hospital in November 2019 (Figure 1), complaining of shortness of breath and poor sleep quality. PD-L1 staining (CST E1L3N) was 30% (Figure 3). Positron emission tomography-CT further indicated thyroid cancer (6.7 x 6.1 x 4.4 cm in size) with multiple metastases in lymph nodes, lung, liver, and bone (Supplemental Figure S1). Subsequently, paclitaxel 300 mg (day 1) was administered every 21 days for a total of five cycles (Figure 1). IV (Figure 1). In response to the first dose, the patient developed grade 3 immune-related rash and grade 1 immune-related hepatotoxicity (elevated alanine aminotransferase and aspartate aminotransferase with levels of less than two times the upper limit of normal). S-1 60 mg oral twice daily was administered for three cycles. Subsequent re-examination of the tumor showed SD condition, and S-1 was administered as a maintenance treatment (Figure 1).
case_images: Pathologic diagnosis of poorly differentiated thyroid squamous cell carcinoma. (a, b) Hematoxylin and eosin staining (magnifications 200x and 400x); (c-h) immunohistochemistry staining: CK5/6 (magnifications 200x and 400x); P40 (magnifications 200x and 400x); P63 (magnifications 200x and 400x).. CK5/6: cytokeratin5&6.
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case_images: TTF-1, as shown in Figure 2. The tumor proportion score (TPS) of
case_images: The TPS of PD-L1 immunohistochemical staining (200x) from the patient.. TPS: tumor proportion score; PD-L1: programmed death ligand 1.
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case_images: PD-L1 staining (CST E1L3N) was 30% (Figure 3). Positron emission tomography-CT further indicated thyroid cancer (6.7 x 6.1 x 4.4 cm in size) with multiple metastases in lymph nodes, lung, liver, and bone (Supplemental Figure S1).
case_images: CT imaging of thyroid (a-e) and liver metastases (f-j) before and after zimberelimab plus nab-paclitaxel in the patient with ATC; arrows: the thyroid lesion and liver metastases. (a) Thyroid lesion before the first-line chemotherapy (tumor size: 5.2 x 7.1 cm). (b) Thyroid lesion after three cycles of gemcitabine+S-1 and one cycle of S-1 (tumor size: 3.4 x 1.9 cm). (c) Thyroid lesion before zimberelimab plus nab-paclitaxel (tumor size: 3.3 x 1.9 cm). (d) Thyroid lesion after three cycles of zimberelimab plus nab-paclitaxel (tumor size: 2.3 x 2.2 cm). (e) Thyroid lesion after nine cycles of zimberelimab plus nab-paclitaxel (tumor size: 3.0 x 1.6 cm). (f) Liver metastases before the first-line chemotherapy (tumor size: 4.8 x 5.8 cm). (g) Liver metastases after three cycles of gemcitabine+S-1 and one cycle of S-1 (tumor size: 1.3 x 1.1 cm). (h) Liver metastases after three cycles of gemcitabine+S-1 and one cycle of S-1 (tumor size: 2.8 x 1.8 cm). (i) Liver metastases after three cycles of zimberelimab plus nab-paclitaxel (tumor size: 1.5 x 1.4 cm). (j) Liver metastases after nine cycles of zimberelimab plus nab-paclitaxel (tumor size: 1.5 x 1.4 cm).. ATC: anaplastic thyroid carcinoma; CT: computed tomography.
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case_images: In January 2020, the baseline CT imaging of thyroid and liver metastases were shown in Figure 4(a) and (f), respectively. In November 2021, the imaging revealed that thyroid lesions remained stable (Figure 4(b) and (c)), while the liver lesions were markedly enlarged from 1.3 x 1.1 to 2.8 x 1.8 cm (Figure 4(g) and (h)), indicating disease progression to the third-line chemotherapy. After three cycles of the treatment, the thyroid lesion shrank from 3.3 x 1.9 to 2.3 x 2.2 cm (Figure 4(d)), and the liver metastases shrank from 2.8 x 1.8 to 1.5 x 1.4 cm (Figure 4(i)), leading to the best overall response (BOR) of partial remission confirmed by subsequent imaging per RECIST v1.1 (Figure 4(c), (d), (h), and (i)). The patient was kept on this combination regimen for a total of nine cycles, which remained stable (Figure 4(e) and (j)).
case_images: Results of five thyroid function tests of the patient from December 2021 to August 2022. The left vertical axis reflects TSH, T4, and FT4 values, whereas the right vertical axis shows the values for T3 and FT3. T3, triiodothyronine (normal range: 1.30-3.10); T4, thyroxine (normal range: 66.00-181.00); FT3, serum-free triiodothyronine (normal range: 3.10-6.80); FT4, free thyroxine (normal range: 12.00-22.00); TSH, thyroid-stimulating hormone (normal range: 0.27-4.20).
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case_images: In April 2022, he was found to develop hypothyroidism (grade 2 irAE) along with an elevated thyroid-stimulating hormone level of 50.10 muIU/ml (normal range: 0.27-4.20) and decreased free thyroxine level of 6.46 pmol/l (normal range: 12.00-22.00) (Figure 5). In August 2022, thyroid function improved (Figure 5); therefore, zimberelimab monotherapy was resumed every 3 weeks.