Advertisement

Targeted Systemic Therapy in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer

  • Levent Kabasakal
  • Onur Erdem Şahin
Chapter

Abstract

With the common use of imaging modalities such as ultrasonography (USG), the incidence of thyroid cancer has increased in recent years. Most of the thyroid cancers are differentiated thyroid cancers (DTC). In the case of DTC, the ability of cancer cells to concentrate iodine makes radioactive iodine (RAI) therapy possible, which is an effective treatment for DTCs. Surgical operation and RAI treatment give a chance to be cured for many thyroid cancer patients. Nonetheless, resistance to RAI treatment develops in a group of patients, and the prognosis worsens. In RAI-refractory (RAI-R) DTC patients, chemotherapeutic drugs such as doxorubicin and cisplatin have been tried, but no successful results have been obtained. In contrast, multiple kinase inhibitors (MKIs) have provided for RAI-R patients a new treatment option. Sorafenib and lenvatinib have been approved by the FDA for RAI-R DTC patients, and phase studies of other MKIs are ongoing.

In addition to offering a new opportunity for RAI-R patients with reduced treatment options, side effect profile creates difficulties in clinical practice. These side effects can affect the patients’ quality of life. For these reasons, treatment of MKIs should be considered in significantly symptomatic patients with rapid progression rather than those with minimal progression or stable, symptom-free patients. Treatment decision should be made by considering patient-based profit-loss rates.

Keywords

DTC RAI-refractory RAI-R Tyrosine kinase inhibitors TKI Multiple kinase inhibitors MKI Sorafenib Lenvatinib 

References

  1. 1.
    National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER). SEER stat fact sheets: thyroid cancer. http://seer.cancer.gov/statfacts/html/thyro.html. Accessed 01 July 2017.
  2. 2.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid Cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.  https://doi.org/10.1089/thy.2015.0020.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Eustatia-Rutten CF, Corssmit EP, Biermasz NR, Pereira AM, Romijn JA, Smit JW. Survival and death causes in differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2006;91:313–9.  https://doi.org/10.1210/jc.2005-1322.CrossRefPubMedGoogle Scholar
  4. 4.
    O’Neill CJ, Oucharek J, Learoyd D, Sidhu SB. Standard and emerging therapies for metastatic differentiated thyroid cancer. Oncologist. 2010;15:146–56.  https://doi.org/10.1634/theoncologist.2009-0190.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nikiforova MN, Nikiforov YE. Molecular genetics of thyroid cancer: implications for diagnosis, treatment and prognosis. Expert Rev Mol Diagn. 2008;8:83–95.  https://doi.org/10.1586/14737159.8.1.83.CrossRefPubMedGoogle Scholar
  6. 6.
    Chow LQ, Santana-Davila R, Pantel A, Roth M, Anderson LN, Failor A, et al. A phase I study of pazopanib in combination with escalating doses of 131I in patients with well-differentiated thyroid carcinoma borderline refractory to radioiodine. PLoS One. 2017;12:e0178325.  https://doi.org/10.1371/journal.pone.0178325.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in locally advanced or metastatic, radioactive iodine-refractory, differentiated thyroid cancer: a randomized, double-blind, phase 3 trial. Lancet. 2014;384:319–28.  https://doi.org/10.1016/S0140-6736(14)60421-9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, et al. Lenvatinib versus placebo in radioiodine-refractory thyroid Cancer. N Engl J Med. 2015;372:621–30.  https://doi.org/10.1056/NEJMoa1406470.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Schmidt A, Iglesias L, Klain M, Pitoia F, Schlumberger MJ. Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation. Arch Endocrinol Metab. 2017;61:81–9.  https://doi.org/10.1590/2359-3997000000245.CrossRefPubMedGoogle Scholar
  10. 10.
    Lorusso L, Pieruzzi L, Biagini A, Sabini E, Valerio L, Giani C, et al. Lenvatinib and other tyrosine kinase inhibitors for the treatment of radioiodine refractory, advanced, and progressive thyroid cancer. Onco Targets Ther. 2016;9:6467–77.  https://doi.org/10.2147/ott.s84625.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Cerrahpaşa Faculty of Medicineİstanbul UniversityIstanbulTurkey

Personalised recommendations