Adjuvant Pembrolizumab after Upfront Multimodal Therapy for Stage IVB Anaplastic Thyroid Cancer

Cabanillas, ME; Busaidy, NL; Gunn, GB; Iyer, PC; Ferrarotto, R; Gule-Monroe, M; Maniakas, A; Williams, MD; Liu, S; Fellman, B; Spiotto, M; Hamidi, S; Akhave, N; Lee, A; Wang, JR; de Sousa, L; Marczyk, VR; Zafereo, M; Dadu, R

doi:10.1089/thy.2025.0194

Adjuvant Pembrolizumab after Upfront Multimodal Therapy for Stage IVB Anaplastic Thyroid Cancer

ThyroidPublished 3 Jul 2025Pooled analysis of a prospective phase 2 trial and a retrospective cohort, with matched controls

Pooled result · Median PFSResultHazard ratio 0.24 CI 0.08–0.73

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Authors' conclusion

Adjuvant pembrolizumab appears to be a safe and effective strategy to prevent recurrences and prolong survival in stage IVB ATC patients following multimodal therapy.

Study context

Population: Stage IVB anaplastic thyroid cancer (ATC) patients treated with multimodal therapy (upfront surgery when feasible, radiation +/- concurrent chemotherapy); median age 59 years; 88% upfront surgery16 per arm
Participants: 16 vs 16

Comparison: Adjuvant pembrolizumab after multimodal therapy vs multimodal therapy without adjuvant pembrolizumab
Adjuvant pembrolizumabn = 16
Controln = 16reference
Outcome: Median progression-free survival (PFS) and recurrence rate

Methodological detailsphase 2 trial closed early due to poor accrual, retrospective cohort of consecutive patients, age and treatment-matched control arm

Phase 2 trial closed early due to poor accrual
Retrospective cohort of consecutive patients
Age and treatment-matched control arm

Pooled result

Median PFS

Hazard ratio

0.24

CI 0.08–0.73

P = 0.006

By group

Adjuvant pembrolizumab

not reached

median

Control

5.4

median · CI 2.04–16.20 · months

Adjuvant pembrolizumabvs Control

HR 0.24 (CI 0.08–0.73); P = 0.006

As reported in the abstract

Further pooled results

Outcome	Adjuvant pembrolizumab	Control	← Lower risk with adjuvant pembrolizumab ←→ Higher risk with adjuvant pembrolizumab →	HR (CI)	P value
Median OS	median not reached	median 31 (CI 13.9, NA) months	0.050.21520	0.11 (0.01–0.83)	P = 0.009
			0.050.21520Hazard ratio (log scale)

Survival rate · 12 and 24 months — Control: 80% (12 months); 52% (24 months) (CI 0.51-0.93 (12 months); 0.25-0.74 (24 months))
PDL1 score in adjuvant pembrolizumab arm: 50% · median · range 0–95%

Survival rate · 12 and 24 months

All patients in the adjuvant arm were still alive at 1- and 2-years

Original publication

Adjuvant Pembrolizumab after Upfront Multimodal Therapy for Stage IVB Anaplastic Thyroid Cancer. Thyroid. Published 3 July 2025. doi:10.1089/thy.2025.0194

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