Modern Therapeutic Approaches in Anaplastic Thyroid Cancer: A Meta-Analytic Review of Randomised and Single Arm Studies on Efficacy and Survival.

Meta-analyses aimed to assess the effectiveness and safety of targeted and contemporary therapies utilised in locally advanced and metastatic anaplastic thyroid cancer (ATC). Employing PRISMA and MOOSE guidelines, PubMed, Scopus, Cochrane Library and Web of Science were explored from the inception of targeted therapy until December 2024. A meta-analysis was performed to evaluate the effectiveness, toxicity and survival outcomes of various mutationally directed agents, chemotherapy and radiotherapy in locally advanced/metastatic ATC cases. A total of 47 studies (26 prospective phase II trials and 21 retrospective studies) involving 980 patients met the inclusion criteria. The pooled results showed an overall response rate (ORR) of 29.7% (95% CI: 25.4-34.2%; = 42.4%; < 0.0001). A total of 49.9% deaths were reported, although a significant number remained alive compared to baseline (mean difference [MD]: 2.07, 95% CI: 1.90-2.24; = 88.6%; < 0.0001). The pooled median progression-free survival (PFS) was 5.4 months (95% CI: 4.0-6.7 months; = 97.9%; < 0.0001). Dabrafenib/trametinib (DT) with and without pembrolizumab and lenvatinib plus pembrolizumab (LP) were associated with higher ORR rates and improved OS and PFS. About 51.% of studies mentioned bio-marker analysis ( [14.7%], [9.2%], [1.1%], [1.0%] and [0.7%]). Toxicity was reported in 94.7% of patients. This meta-analysis found that DT could be a promising first-line treatment option for -mutated ATC, with or without immunotherapy. Alternatively, LP shows potential in wild-type and -overexpressing cases. Routine biomarker analysis remains critical for optimising ATC management strategies.