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Publications

Journal Article Review Letter Epublish

PubMed: 42747610 DOI: 10.1007/s12020-026-04797-z

Neoadjuvant therapy in thyroid cancer: an emerging approach.

Endocrine 91(1)

Authors: Fabián Pitoia, Inés Califano, Marika Russell, David Shonka, Pierpaolo Trimboli, Laura Fugazzola, Gregory Randolph

Affiliations

  • Division of Endocrinology, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina.
  • Department of Endocrinology, Instituto de Oncologia AH Roffo, University of Buenos Aires, Buenos Aires, Argentina.
  • Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
  • Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA.
  • Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
  • Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.

Abstract

PURPOSE

Neoadjuvant therapy in thyroid cancer has emerged as a promising strategy for selected patients with locally advanced disease, but its rationale and clinical impact vary substantially across histologies.

METHODS

This comment examines the current evidence and clinical rationale for neoadjuvant therapy across anaplastic, differentiated and medullary thyroid carcinomas.

RESULTS

For BRAF V600E-mutated anaplastic thyroid carcinoma, targeted therapy has created a meaningful window for surgical resection in patients previously considered unresectable, representing the clearest proof of concept. In differentiated thyroid cancer, preoperative systemic therapy remains more selective and investigational, mainly supported by case reports, small series, and early clinical trial data, with unresolved questions regarding patient selection, optimal treatment, surgical endpoints, and durability of benefit. With medullary thyroid carcinoma, evidence remains even more limited.

CONCLUSIONS

Neoadjuvant therapy should not be viewed as a uniform paradigm across thyroid cancers, but as a histology-specific strategy with applicability based on tumor responsiveness amounting to improved resectability, reduced surgical morbidity, durable disease control, and real-world feasibility.

MeSH

Neoplasms, Thyroid Gland, Hormones, Neoadjuvant Therapy, Thyroid Neoplasms, Therapeutics