Neoadjuvant Lenvatinib Shrinks Thyroid Tumor and Improves Surgical Outcomes in Advanced Thyroid Cancer
核心洞察
A clinical trial at UT MD Anderson evaluated the targeted therapy lenvatinib given before surgery to patients with thyroid cancer, with one patient's tumor shrinking by 25% after two months of treatment.
The neoadjuvant approach enabled a total thyroidectomy and neck dissection that preserved all critical nerves and vascular structures, removing a melon-sized tumor and 90 lymph nodes.
The case highlights how preoperative targeted therapy can improve surgical outcomes in locally advanced thyroid cancer, though the patient later developed a separate pancreatic cancer (搜索).
A clinical trial at UT MD Anderson Cancer Center is evaluating how well the targeted therapy lenvatinib works when given to thyroid cancer patients before surgery, an approach that helped shrink one patient's tumor by 25% and preserve critical anatomical structures during a complex operation.
Armando Gallegos was diagnosed with papillary thyroid cancer (搜索) at age 52 after visiting a clinic near his home in Austin for swelling in his neck. Because of the large size of the tumor, local providers referred him to UT MD Anderson in Houston, where he met head and neck surgeon Anastasios Maniakas, M.D., Ph.D., on March 6, 2024.
"I went into the appointment feeling down, thinking I was going to die from this disease. Then Dr. Maniakas walked in, and it was the first positive light I'd had since my diagnosis," Gallegos recalled. "He told me he specialized in treating thyroid cancer and does these types of surgeries all the time."
Neoadjuvant Targeted Therapy
At UT MD Anderson, Gallegos also met endocrine specialist Ramona Dadu, M.D., who told him about a clinical trial evaluating how well the targeted therapy lenvatinib worked when given to thyroid cancer patients before surgery.
"I walked out of the appointment thinking that I just had to take a pill once a day for a few months to shrink the tumor," he said.
Gallegos took lenvatinib for two months, and it reduced the tumor by 25%. During this period, he also lost 60 pounds by adhering to a low-carbohydrate diet and limiting sweets, a change encouraged by Maniakas to reduce surgical risks such as blood clots or breathing difficulties. At the time of his diagnosis, Gallegos weighed about 430 pounds, which is considered obese.
Surgical Outcome
On June 3, 2024, Maniakas performed a total thyroidectomy and neck dissection. He removed a tumor the size of a small melon and 90 lymph nodes from Gallegos's neck. The surgery took 12 hours.
Because of the clinical trial available at UT MD Anderson, doctors were able to shrink the tumor and improve surgical outcomes. All of Gallegos's critical nerves and vascular structures came out fully intact.
"My wife and youngest son were there, and they said every couple of hours, someone would give them an update," Gallegos said. "They never felt like they were there alone."
Gallegos spent three nights in the hospital before returning home to Austin, where he spent a month recovering.
A Second, Separate Cancer Diagnosis
In December 2024, Gallegos began experiencing what he thought was severe heartburn. A CT scan in January did not show anything concerning, and his doctor initially suspected diverticulitis or a fatty liver. However, when coworkers noticed his skin turning yellow, Gallegos went to the emergency room, where a CT scan revealed a blockage in his bile duct.
The yellowing of his skin was due to elevated bilirubin caused by the blockage, which also produced his abdominal pain. The blockage turned out to be a pancreatic tumor.
"That was the scariest thing I'd been told," Gallegos said.
He returned to UT MD Anderson, where Dadu referred him to surgical oncologist Rebecca Snyder, M.D. Snyder recommended chemotherapy to shrink the tumor before surgery and advised him to lose 100 pounds to make pancreatic surgery safer. With guidance from internal medicine specialist Zayd Razouki, M.D., who leads a weight management program at UT MD Anderson, Gallegos underwent eight cycles of FOLFIRINOX chemotherapy and lost 90 pounds.
After a CT scan showed slight inflammation in his pancreas, Snyder had him stop chemotherapy, and he instead completed 10 sessions of radiation therapy at a facility near Austin. On January 6, 2026, he underwent a 10-hour Whipple procedure in which Snyder removed the head of his pancreas, bile duct, duodenum, gallbladder and 28 lymph nodes. There were clear margins, the cancer had responded to chemotherapy and radiation, and only one of the 27 lymph nodes came back as cancerous.
Following the Whipple procedure, Gallegos completed an additional four cycles of FOLFIRINOX chemotherapy to destroy any microscopic cancer cells that may remain and reduce the risk of recurrence.
A Broader Context for Aggressive Thyroid Cancer
The case of neoadjuvant lenvatinib in papillary thyroid cancer (搜索) sits alongside UT MD Anderson's broader expertise in aggressive thyroid malignancies. In a separate case, Leslie Mellinger was diagnosed in June 2021 with anaplastic thyroid cancer (搜索), the rarest and most aggressive type of thyroid cancer. She was initially told she had three months to live.
Mellinger was referred to UT MD Anderson's Anaplastic Thyroid Cancer (搜索) Clinic, where she met head and neck surgeon Mark Zafereo, M.D., and oncologic endocrinologist Maria Cabanillas, M.D. On June 16, 2021, Zafereo performed a complete thyroidectomy with a central and right neck dissection to remove a 7.5 cm tumor on her right thyroid. Three of the 25 lymph nodes removed were cancerous, and her official diagnosis was stage 4B anaplastic thyroid cancer.
"Before my surgery, I was told I might need a trach and a feeding tube," Mellinger said. "But when I woke up in the recovery room, it took me a while to realize that I didn't have either." Zafereo explained that after removing her thyroid, the whole tumor came off without touching her esophagus or voice box. Recently, Mellinger celebrated five years with no evidence of disease.
These cases illustrate how specialized, multidisciplinary cancer care—including neoadjuvant targeted therapy and expert surgical management—can improve outcomes for patients facing complex and aggressive thyroid cancers.