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Wang Z, Fan X, Zha X, Xu Y, Yin Z, Rixiati Y, Yu F. A Proposed Modified Staging System for Medullary Thyroid Cancer: A SEER Analysis With Multicenter Validation. Oncologist 2024; 29:e59-e67. [PMID: 37311049 PMCID: PMC10769787 DOI: 10.1093/oncolo/oyad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for medullary thyroid cancer (MTC) was implemented in 2018. However, its ability to predict prognosis remains controversial. PATIENTS AND METHODS Patient data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and multicenter datasets. Overall survival was the primary end-point of the present study. The concordance index (C-index) was used to assess the efficacy of various models to predict prognostic outcomes. RESULTS A total of 1450 MTC patients were selected from the SEER databases and 349 in the multicenter dataset. According to the AJCC staging system, there were no significant survival differences between T4a and T4b categories (P = .299). The T4 category was thus redefined as T4a' category (≤3.5 cm) and T4b' category (>3.5 cm) based on the tumor size, which was more powerful for distinguishing the prognosis (P = .003). Further analysis showed that the T category was significantly associated with both lymph node (LN) location and count (P < .001). Therefore, the N category was modified by combining the LN location and count. Finally, the above-mentioned novel T and N categories were adopted to modify the 8th AJCC classification using the recursive partitioning analysis principle, and the modified staging system outperformed the current edition (C-index, 0.811 vs. 0.792). CONCLUSIONS The 8th AJCC staging system was improved based on the intrinsic relationship among the T category, LN location, and LN count, which would have a positive impact on the clinical decision-making process and appropriate surveillance.
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Affiliation(s)
- Zhengshi Wang
- Thyroid Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Xin Fan
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaojuan Zha
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Yong Xu
- Department of Laboratory, Yueyang Hospital, Hunan Normal University, Yueyang, People’s Republic of China
| | - Zhiqiang Yin
- Thyroid Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Youlutuziayi Rixiati
- Department of Pathology, Fudan University Huashan Hospital, Shanghai, People’s Republic of China
| | - Fei Yu
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Ciarletto AM, Narick C, Malchoff CD, Massoll NA, Labourier E, Haugh K, Mireskandari A, Finkelstein SD, Kumar G. Analytical and clinical validation of pairwise microRNA expression analysis to identify medullary thyroid cancer in thyroid fine-needle aspiration samples. Cancer Cytopathol 2020; 129:239-249. [PMID: 33017868 PMCID: PMC7984450 DOI: 10.1002/cncy.22365] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
Background Medullary thyroid carcinoma (MTC) is an aggressive malignancy originating from the parafollicular C cells. Preoperatively, thyroid nodule fine‐needle aspiration cytology (FNAC) and pathogenic gene mutations are definitive in approximately one‐half of cases. MicroRNAs (miRNAs) are endogenous, noncoding, single‐stranded RNAs that regulate gene expression, a characteristic that confers the potential for identifying malignancy. In the current study, the authors hypothesized that differential pairwise (diff‐pair) analysis of miRNA expression levels would reliably identify MTC in FNA samples. Methods The relative abundance of 10 different miRNAs in total nucleic acids was obtained from ThyraMIR test results. Diff‐pair analysis was performed by subtracting the critical threshold value of one miRNA from the critical threshold values of other miRNAs. Next‐generation sequencing with the ThyGeNEXT panel identified oncogenic gene alterations. The discovery cohort consisted of 30 formalin‐fixed, paraffin‐embedded benign and malignant thyroid neoplasms, including 4 cases of MTC. After analytical validation, clinical validation was performed using 3 distinct cohorts (total of 7557 specimens). Results In the discovery cohort, 9 diff‐pairs were identified as having significant power using the Kruskal‐Wallis test (P < .0001) to distinguish MTC samples from non‐MTC samples. The assay correctly classified all MTC and non‐MTC samples in the analytical validation study and in the 3 clinical validation cohorts. The overall test accuracy was 100% (95% confidence interval, 99%‐100%). In indeterminate FNAC samples, the sensitivity of the diff‐pair analysis was greater than that of the MTC‐specific mutation analysis (100% vs 25%; P = .03). Conclusions Pairwise miRNA expression analysis of ThyraMIR results were found to accurately predict MTC in thyroid FNA samples, including those with indeterminate FNAC findings. The authors have developed and validated a microRNA (miRNA) test for the detection of medullary thyroid cancer (MTC) in preoperative thyroid nodule samples. The method, based on differential pairwise analysis of miRNA expression data generated using the ThyraMIR Thyroid miRNA Classifier, accurately predicts MTC with 100% sensitivity and 100% specificity in thyroid fine‐needle aspiration biopsies.
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Affiliation(s)
- Andrea M Ciarletto
- Interpace Diagnostics Laboratory, Interpace Biosciences Inc, New Haven, Connecticut
| | - Christina Narick
- Interpace Diagnostics, Interpace Biosciences Inc, Pittsburgh, Pennsylvania, United States
| | - Carl D Malchoff
- Carole and Ray Neag Comprehensive Cancer Center, UConn Health, Farmington, Connecticut
| | - Nicole A Massoll
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | | | - Keith Haugh
- Interpace Diagnostics, Interpace Biosciences Inc, Pittsburgh, Pennsylvania, United States
| | - Alidad Mireskandari
- Interpace Diagnostics Laboratory, Interpace Biosciences Inc, New Haven, Connecticut
| | - Sydney D Finkelstein
- Interpace Diagnostics Laboratory, Interpace Biosciences Inc, New Haven, Connecticut.,Interpace Diagnostics, Interpace Biosciences Inc, Pittsburgh, Pennsylvania, United States
| | - Gyanendra Kumar
- Interpace Diagnostics Laboratory, Interpace Biosciences Inc, New Haven, Connecticut
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Zhu J, Li X, Wei X, Yang X, Zhao J, Zhang S, Guo Z. The application value of modified thyroid imaging report and data system in diagnosing medullary thyroid carcinoma. Cancer Med 2019; 8:3389-3400. [PMID: 31070290 PMCID: PMC6601574 DOI: 10.1002/cam4.2217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is highly malignant and quite different from the most common papillary thyroid carcinoma (PTC). However, most of the ultrasonic evaluation systems mainly aim at PTC at present. This study aims to evaluate the applicability of modified TI-RADS in diagnosing MTC and compare the sonographic differences of MTC, PTC, and benign nodules. Three thousand two hundred and forty-two thyroid nodules images confirmed by pathology were categorized according to modified TI-RADS and ACR TI-RADS classification. The performances of two TI-RADS were assessed by ROC curves. The correlations between classifications with the pathology and the consistency of different doctors were evaluated. The ultrasonic differences of MTC, PTC, and benign nodules were analyzed. As a result, the number of high suspicious US features increased, the malignant risk of nodules also increased of two classifications, with significant differences between categories (P < 0.001). Spearman correlation coefficients were 0.751 (modified TI-TADS) and 0.744 (ACR TI-RADS). Areas under the ROC curve of the modified TI-RADS and ACR TI-RADS were 0.960 and 0.872 (P < 0.001). At Best cut off points, the diagnostic value of modified TI-RADS was higher than that of ACR TI-RADS with a higher specificity, PPV, accuracy, and Youden index). By using modified TI-RADS to diagnose MTC and PTC, the sensitivity, specificity, NPV, accuracy, and Youden index were higher in MTC than PTC. The Kendall's correlation coefficients were 0.962, 0.930, and 0.987. MTC had special ultrasonography characters compared with PTC and benign nodules. These results suggest that modified TI-RADS is better than ACR TI-RADS in diagnosing thyroid carcinomas. Diagnostic value to MTC of modified TI-RADS is slightly higher than that to PTC, and the categorical results of different doctors were consistent. MTC had several particular features contrast to PTC and benign nodules.
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Affiliation(s)
- Jialin Zhu
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Xing Li
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Xi Wei
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Xueling Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Jing Zhao
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Sheng Zhang
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center for CancerTianjinChina
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Maciel LMZ, Magalhães PKR. Medullary thyroid carcinoma - Adverse events during systemic treatment: risk-benefit ratio. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:398-402. [PMID: 28658345 PMCID: PMC10118930 DOI: 10.1590/2359-3997000000267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/26/2016] [Indexed: 11/21/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from parafollicular C cells of the thyroid and associated with mutations in the proto-oncogene REarranged during Transfection (RET). The prognosis of MTC depends on clinical stage, with a 95.6% 10-year survival rate among patients with localized disease and 40% among patients with advanced disease. Standard chemotherapy and radiotherapy have no significant impact on the overall survival of these patients and two tyrosine kinase receptor inhibitors (TKIs), vandetanib and cabozantinib, have been recently approved for the systemic treatment of locally advanced or metastatic MTC. However, since patients with MTC and residual or recurrent disease may have an indolent course with no need for systemic treatment, and since these drugs are highly toxic, it is extremely important to select the patients who will receive these drugs in a correct manner. It is also essential to carefully monitor patients using TKI regarding possible adverse effects, which should be properly managed when occurring.
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Affiliation(s)
- Léa Maria Zanini Maciel
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Patrícia Künzle Ribeiro Magalhães
- Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil
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Song H, Lin C, Yao E, Zhang K, Li X, Wu Q, Chuang PT. Selective Ablation of Tumor Suppressors in Parafollicular C Cells Elicits Medullary Thyroid Carcinoma. J Biol Chem 2017; 292:3888-3899. [PMID: 28119454 PMCID: PMC5339769 DOI: 10.1074/jbc.m116.765727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/23/2017] [Indexed: 12/26/2022] Open
Abstract
Among the four different types of thyroid cancer, treatment of medullary thyroid carcinoma poses a major challenge because of its propensity of early metastasis. To further investigate the molecular mechanisms of medullary thyroid carcinoma and discover candidates for targeted therapies, we developed a new mouse model of medullary thyroid carcinoma based on our CGRPCreER mouse line. This system enables gene manipulation in parafollicular C cells in the thyroid, the purported cells of origin of medullary thyroid carcinoma. Selective inactivation of tumor suppressors, such as p53, Rb, and Pten, in mature parafollicular C cells via an inducible Cre recombinase from CGRPCreER led to development of murine medullary thyroid carcinoma. Loss of Pten accelerated p53/Rb-induced medullary thyroid carcinoma, indicating interactions between pathways controlled by tumor suppressors. Moreover, labeling differentiated parafollicular C cells by CGRPCreER allows us to follow their fate during malignant transformation to medullary thyroid tumor. Our findings support a model in which mutational events in differentiated parafollicular C cells result in medullary thyroid carcinoma. Through expression analysis including RNA-Seq, we uncovered major signaling pathways and networks that are perturbed following the removal of tumor suppressors. Taken together, these studies not only increase our molecular understanding of medullary thyroid carcinoma but also offer new candidates for designing targeted therapies or other treatment modalities.
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Affiliation(s)
- Hai Song
- From the Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou 310058, China and
- the Cardiovascular Research Institute, University of California, San Francisco, California 94158
| | - Chuwen Lin
- the Cardiovascular Research Institute, University of California, San Francisco, California 94158
| | - Erica Yao
- the Cardiovascular Research Institute, University of California, San Francisco, California 94158
| | - Kuan Zhang
- the Cardiovascular Research Institute, University of California, San Francisco, California 94158
| | - Xiaoling Li
- From the Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou 310058, China and
| | - Qingzhe Wu
- From the Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou 310058, China and
| | - Pao-Tien Chuang
- the Cardiovascular Research Institute, University of California, San Francisco, California 94158
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Mohammadi M, Hedayati M. A Brief Review on The Molecular Basis of Medullary Thyroid Carcinoma. CELL JOURNAL 2016; 18:485-492. [PMID: 28042533 PMCID: PMC5086327 DOI: 10.22074/cellj.2016.4715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/25/2016] [Indexed: 01/03/2023]
Abstract
Approximately 5-10% of all thyroid cancers are medullary thyroid carcinomas (MTC). MTC
is mainly sporadic in nature, but 20-30% of cases are hereditary. Genetic testing for hereditary
MTC is very important for the patient and his family, but the patients must be receiving
appropriate genetic counseling. About 98% of patients with hereditary MTC have
germline mutations in exons 10, 11, 13, 14, 15, 16 and intron 16 of the REarrangement
during transfection (RET) proto-oncogene, but the etiology of the more frequent sporadic
form of MTC (sMTC) is not well understood. Recently, it has been reported that apparently
sporadic MTC may involve point mutations in BRAF and RAS genes, with an overall
prevalence of almost 10%. Also alteration and abnormal expression of miRNA has been
described in MTC. In this review, we attempted to mention some mutations and molecular
changes in sporadic and hereditary MTC pathogenesis.
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Affiliation(s)
- Masoumeh Mohammadi
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Hoff AO. The evolving field of thyroid cancer: refinement of old and creation of new paradigms. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:283-284. [PMID: 26331313 DOI: 10.1590/2359-3997000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 07/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Ana O Hoff
- Departamento de Endocrinologia, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, SP, BR
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Ferrari SM, Politti U, Spisni R, Materazzi G, Baldini E, Ulisse S, Miccoli P, Antonelli A, Fallahi P. Sorafenib in the treatment of thyroid cancer. Expert Rev Anticancer Ther 2015; 15:863-74. [PMID: 26152651 DOI: 10.1586/14737140.2015.1064770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sorafenib has been evaluated in several Phase II and III studies in patients with locally advanced/metastatic radioactive iodine-refractory differentiated thyroid carcinomas (DTCs), reporting partial responses, stabilization of the disease and improvement of progression-free survival. Best responses were observed in lung metastases and minimal responses in bone lesions. On the basis of these studies, sorafenib was approved for the treatment of metastatic DTC in November 2013. Few studies suggested that reduction of thyroglobulin levels, or of average standardized uptake value at the fluorodeoxyglucose-PET, could be helpful for the identification of responding patients; but further studies are needed to confirm these results. Tumor genetic marker levels did not have any prognostic or predictive role in DTC patients.The most common adverse events observed included skin toxicity and gastrointestinal and constitutional symptoms. Encouraging results have also been observed in patients with medullary thyroid cancer. Many studies are ongoing to evaluate the long-term efficacy and tolerability of sorafenib in DTC patients.
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Affiliation(s)
- Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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Bertazza L, Barollo S, Radu CM, Cavedon E, Simioni P, Faggian D, Plebani M, Pelizzo MR, Rubin B, Boscaro M, Pezzani R, Mian C. Synergistic antitumour activity of RAF265 and ZSTK474 on human TT medullary thyroid cancer cells. J Cell Mol Med 2015; 19:2244-52. [PMID: 26081844 PMCID: PMC4568928 DOI: 10.1111/jcmm.12612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/09/2015] [Indexed: 12/27/2022] Open
Abstract
Medullary thyroid cancer (MTC) is an aggressive malignancy responsible for up to 14% of all thyroid cancer-related deaths. It is characterized by point mutations in the rearranged during transfection (RET) proto-oncogene. The activated RET kinase is known to signal via extracellular signal regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K), leading to enhanced proliferation and resistance to apoptosis. In the present work, we have investigated the effect of two serine/threonine-protein kinase B-Raf (BRAF) inhibitors (RAF265 and SB590885), and a PI3K inhibitor (ZSTK474), on RET-mediated signalling and proliferation in a MTC cell line (TT cells) harbouring the RETC634W activating mutation. The effects of the inhibitors on VEGFR2, PI3K/Akt and mitogen-activated protein kinases signalling pathways, cell cycle, apoptosis and calcitonin production were also investigated. Only the RAF265+ ZSTK474 combination synergistically reduced the viability of treated cells. We observed a strong decrease in phosphorylated VEGFR2 for RAF265+ ZSTK474 and a signal reduction in activated Akt for ZSTK474. The activated ERK signal also decreased after RAF265 and RAF265+ ZSTK474 treatments. Alone and in combination with ZSTK474, RAF265 induced a sustained increase in necrosis. Only RAF265, alone and combined with ZSTK474, prompted a significant drop in calcitonin production. Combination therapy using RAF265 and ZSTK47 proved effective in MTC, demonstrating a cytotoxic effect. As the two inhibitors have been successfully tested individually in clinical trials on other human cancers, our preclinical data support the feasibility of their combined use in aggressive MTC.
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Affiliation(s)
- Loris Bertazza
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Claudia Maria Radu
- 5th Chair of Internal Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Elisabetta Cavedon
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Simioni
- 5th Chair of Internal Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Diego Faggian
- Department of Laboratory Medicine, Padua University Hospital, Padua, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, Padua University Hospital, Padua, Italy
| | - Maria Rosa Pelizzo
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Surgery Unit, University of Padua, Padua, Italy
| | - Beatrice Rubin
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Raffaele Pezzani
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy
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Soba P, Han C, Zheng Y, Perea D, Miguel-Aliaga I, Jan LY, Jan YN. The Ret receptor regulates sensory neuron dendrite growth and integrin mediated adhesion. eLife 2015; 4. [PMID: 25764303 PMCID: PMC4391025 DOI: 10.7554/elife.05491] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/11/2015] [Indexed: 12/11/2022] Open
Abstract
Neurons develop highly stereotyped receptive fields by coordinated growth of their dendrites. Although cell surface cues play a major role in this process, few dendrite specific signals have been identified to date. We conducted an in vivo RNAi screen in Drosophila class IV dendritic arborization (C4da) neurons and identified the conserved Ret receptor, known to play a role in axon guidance, as an important regulator of dendrite development. The loss of Ret results in severe dendrite defects due to loss of extracellular matrix adhesion, thus impairing growth within a 2D plane. We provide evidence that Ret interacts with integrins to regulate dendrite adhesion via rac1. In addition, Ret is required for dendrite stability and normal F-actin distribution suggesting it has an essential role in dendrite maintenance. We propose novel functions for Ret as a regulator in dendrite patterning and adhesion distinct from its role in axon guidance.
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Affiliation(s)
- Peter Soba
- Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf (UKE), University of Hamburg, Hamburg, Germany
| | - Chun Han
- Department of Physiology, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, United States
| | - Yi Zheng
- Department of Physiology, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, United States
| | - Daniel Perea
- Gut Signalling and Metabolism Group, MRC Clinical Sciences Centre, Imperial College London, London, United Kingdom
| | - Irene Miguel-Aliaga
- Gut Signalling and Metabolism Group, MRC Clinical Sciences Centre, Imperial College London, London, United Kingdom
| | - Lily Yeh Jan
- Department of Physiology, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, United States
| | - Yuh Nung Jan
- Department of Physiology, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, United States
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11
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Jia X, Liu X, Wang J, Wang M, Guo H, Liu M. Synthesis and antitumor activity of capecitabine derivatives. Chem Res Chin Univ 2015. [DOI: 10.1007/s40242-015-4282-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Lyra J, Vinagre J, Batista R, Pinto V, Prazeres H, Rodrigues F, Eloy C, Sobrinho-Simões M, Soares P. mTOR activation in medullary thyroid carcinoma with RAS mutation. Eur J Endocrinol 2014; 171:633-40. [PMID: 25163725 DOI: 10.1530/eje-14-0389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Rearranged during transfection (RET) mutations are well-known genetic events in sporadic and familial medullary thyroid carcinoma (FMTC). The presence of RAS mutations in sporadic cases, challenging the RET paradigm in these tumors, has been recently reported. We intend to evaluate mTOR pathway activation in RET- and RAS-mutated MTC. MATERIALS AND METHODS In this study, we analysed the presence of RET, H-RAS, and K-RAS mutations in a series of 87 MTCs (82 apparently sporadic and five FMTCs; five apparently sporadic MTCs were eventually found to be familial). We also evaluated mTOR activation--using the expression of its downstream effector phospho-S6 ribosomal protein (p-S6) and the expression of the mTOR inhibitor, phosphatase and tensin homologue deleted on chromosome 10 (PTEN)--by immunohistochemistry. RESULTS Our results revealed that RET mutations were present in 52.9% of the cases (46/87) and RAS mutations in 12.6% (11/87) of the whole series of MTCs and 14.3% of the 77 sporadic MTCs. The presence of RET and RAS mutations was mutually exclusive. RAS mutations were significantly associated with higher intensity of p-S6 expression (P=0.007), suggesting that the mTOR pathway is activated in such MTCs. We observed also an increased expression of p-S6 in invasive tumors (P=0.042) and in MTCs with lymph node metastases (P=0.046). Cytoplasmic PTEN expression was detected in 58.8% of the cases; cases WT for RAS showed a significantly lower expression of PTEN (P=0.045). CONCLUSIONS We confirmed the presence of RAS mutation in 14.3% of sporadic MTCs and report, for the first time, an association between such mutations and the activation of the mTOR pathway. The evaluation of the mTOR activation by pS6 expression may serve as an indicator of invasive MTC.
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Affiliation(s)
- Joana Lyra
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - João Vinagre
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Rui Batista
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Vasco Pinto
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Hugo Prazeres
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Fernando Rodrigues
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Catarina Eloy
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Manuel Sobrinho-Simões
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
| | - Paula Soares
- Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal Medical FacultyUniversity of Porto, Al. Prof. Hernâni Monteiro, P-4200 Porto, PortugalInstitute of Molecular Pathology and Immunology of the University of Porto (Ipatimup) - Cancer BiologyRuaDr. Roberto Frias, s/n, 4200-465 Porto, PortugalMolecular Pathology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalEndocrinology Service of the Portuguese Institute of Oncology of Coimbra FGEPE, Av. Bissaya Barreto, 98, 3000-075 Coimbra, PortugalDepartment of PathologyHospital de S. João, Al. Prof. Hernâni Monteiro, P-4200 Porto, Portugal
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Rajhbeharrysingh U, Taylor M, Milas M. Medical therapy for advanced forms of thyroid cancer. Surg Clin North Am 2014; 94:541-71. [PMID: 24857576 DOI: 10.1016/j.suc.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
More options than ever before are currently available for medical therapy in patients who present with advanced thyroid cancer or develop surgically unresectable recurrences or symptomatic or progressive disease. The newer medical therapies have addressed the need to find effective therapies beyond the conventional treatment with radioactive iodine, thyroid stimulating hormone suppression, and palliative cytotoxic chemotherapy for patients with advanced thyroid cancer. Although tumor responses to these medical therapies vary by type of thyroid cancer and type of therapy selected, they remain encouraging and provide therapeutic options for selected patients while new drugs are in development.
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Affiliation(s)
- Uma Rajhbeharrysingh
- Department of Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Matthew Taylor
- Division of Hematology & Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Mira Milas
- Department of Surgery, Knight Cancer Institute, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L619, Portland, OR 97239, USA.
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Mancikova V, Inglada-Pérez L, Curras-Freixes M, de Cubas AA, Gómez Á, Letón R, Kersten I, Leandro-García LJ, Comino-Méndez I, Apellaniz-Ruiz M, Sánchez L, Cascón A, Sastre-Marcos J, García JF, Rodríguez-Antona C, Robledo M. VEGF, VEGFR3, and PDGFRB protein expression is influenced by RAS mutations in medullary thyroid carcinoma. Thyroid 2014; 24:1251-5. [PMID: 24754736 DOI: 10.1089/thy.2013.0579] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKIs) have achieved remarkable clinical results in medullary thyroid carcinoma (MTC) patients. However, the considerable variability in patient response to treatment with TKIs remains largely unexplained. There is evidence that it could be due, at least in part, to alterations in genes associated with the disease via their effect on the expression of TKI targets. The objective of this study was to evaluate the influence of RAS mutations on the expression levels in MTC tumors of eight key TKI target proteins. METHODS We assessed by immunohistochemistry the expression of EGFR, KIT, MET, PDGFRB, VEGF, VEGFR1, VEGFR2, and VEGFR3 in a series of 84 primary MTC tumors that had previously been molecularly characterized, including 14 RAS-positive, 18 RET(M918T)-positive, and 24 RET(C634)-positive tumors, as well as 15 wild-type tumors with no mutations in the RET or RAS genes. RESULTS In contrast to RET-positive tumors, RAS-positive tumors expressed neither PDGFRB nor MET (p=0.0060 and 0.047, respectively). Similarly, fewer RAS-positive than RET-related tumors expressed VEGFR3 (p=0.00062). Finally, wild-type tumors expressed VEGF more often than both RAS- and RET-positive tumors (p=0.0082 and 0.011, respectively). CONCLUSIONS This is the first study identifying that the expression of TKI targets differs according to the presence of RAS mutations in MTC. This information could potentially be used to select the most beneficial TKI treatment for these patients.
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Affiliation(s)
- Veronika Mancikova
- 1 Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre , Madrid, Spain
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15
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Barroso-Sousa R, Lerario AM, Evangelista J, Papadia C, Lourenço DM, Lin CS, Kulcsar MA, Fragoso MC, Hoff AO. Complete resolution of hypercortisolism with sorafenib in a patient with advanced medullary thyroid carcinoma and ectopic ACTH (adrenocorticotropic hormone) syndrome. Thyroid 2014; 24:1062-6. [PMID: 24499195 DOI: 10.1089/thy.2013.0571] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The treatment of advanced medullary thyroid carcinoma (MTC) has evolved significantly over the past decade. The discovery of genetic abnormalities in MTC has led to the development of targeted therapies such as vandetanib and cabozantinib. Other kinase inhibitors (KI), such as sorafenib, have been investigated in this setting and are an alternative therapeutic option. The lack of specificity of these KIs to a single target may result in additional, unexpected effects. In this report, we describe a patient with metastatic MTC and Ectopic ACTH (adrenocorticotropic hormone) Syndrome in whom treatment with sorafenib resulted in complete resolution of hypercortisolism. SUMMARY A 45-year-old male with progressive metastatic MTC presented with clinical manifestations suspicious for Cushing's syndrome. Investigation revealed ACTH-dependent hypercortisolism suggestive of Ectopic ACTH Syndrome. Treatment with sorafenib 400 mg twice a day was initiated resulting in a rapid and significant reduction of cortisol and ACTH levels associated with dramatic clinical improvement. The rapid and effective control of hypercortisolism in the absence of a significant tumor reduction raises the question of whether sorafenib may have a direct effect on ACTH or cortisol hypersecretion. CONCLUSIONS This report suggests a previously unknown potential effect of sorafenib on the pituitary-adrenal axis. Further studies will be necessary to investigate the role of sorafenib in other cases of ACTH excess and to understand the mechanisms by which it alters steroid synthesis, action, or secretion.
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Affiliation(s)
- Romualdo Barroso-Sousa
- 1 Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo (ICESP) , São Paulo, Brazil
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16
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Colombo JR, Wein RO. Cabozantinib for progressive metastatic medullary thyroid cancer: a review. Ther Clin Risk Manag 2014; 10:395-404. [PMID: 24920914 PMCID: PMC4043815 DOI: 10.2147/tcrm.s46041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Medullary thyroid cancer is uncommon and patients typically present with advanced disease. Treatment options for patients with progressive, metastatic medullary thyroid cancer had been limited until recently. Tyrosine kinase inhibitors have garnered increasing interest in this subset of patients. The US Food and Drug Administration recently approved cabozantinib, a tyrosine kinase inhibitor, after promising results were shown in a large Phase III clinical trial. This review summarizes the clinical pharmacology, clinical trials, and safety data for cabozantinib and concludes with a discussion of possible future directions for the treatment of medullary thyroid cancer.
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Affiliation(s)
- Joshua R Colombo
- Department of Otolaryngology, Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | - Richard O Wein
- Department of Otolaryngology, Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
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17
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Update on the molecular diagnosis and targeted therapy of thyroid cancer. Med Oncol 2014; 31:973. [PMID: 24788398 DOI: 10.1007/s12032-014-0973-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/18/2014] [Indexed: 02/07/2023]
Abstract
Thyroid cancer (TC) is the most common endocrine malignancy with steadily increasing incidence over the past few decades. Although standard strategies for the management of TC offer optimal outcomes in TC patients with favorable histological types at early stage, challenges arising from diagnosis and therapy still exist during clinical practice. A number of genetic alterations have been described in thyroid cancer, which provides an unprecedented opportunity for the identification of novel diagnostic and prognostic molecular markers as well as novel therapeutic targets. Molecular-targeted therapies, which have been investigated recently with increasing success, may prove to be a breakthrough in patients with advanced, radioiodine-refractory thyroid cancers. This review summarizes the latest progression in molecular diagnosis and targeted therapy of TC.
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Abstract
The term red face is reserved for lesions located exclusively or very predominantly on the face that result from changes in cutaneous blood flow triggered by multiple different conditions. Facial erythema may not only present clinically as a distinct entity, but can also be a sign of other diseases. Patients with a red face challenge clinicians to consider a broad differential diagnosis. Diagnosis is based on date and mode of appearance, characteristics of the erythema, functional signs, and associated systemic manifestations. In most cases, the cause is a benign disease such as rosacea, contact dermatitis, photodermatosis, and climacterium, and a thorough history and physical examination is enough to make a diagnosis; facial erythema may also present as a symptom of drug allergies, cardiac disease, carcinoid syndrome, pheochromocytoma, mastocytosis, and anaphylaxis, as well as some rare causes such as medullary carcinoma of the thyroid, pancreatic cell tumor, and renal carcinoma where further laboratory, radiologic, or histopathologic studies are required. In this review, the mechanisms of flushing, its clinical differential diagnosis, and management of various conditions that cause flushing are discussed.
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Affiliation(s)
- Güliz İkizoğlu
- Department of Dermatology, Mersin University, School of Medicine, Mersin, Turkey.
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19
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Akeno N, Miller AL, Ma X, Wikenheiser-Brokamp KA. p53 suppresses carcinoma progression by inhibiting mTOR pathway activation. Oncogene 2014; 34:589-99. [PMID: 24469052 PMCID: PMC4112184 DOI: 10.1038/onc.2013.589] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/18/2013] [Accepted: 12/18/2013] [Indexed: 12/24/2022]
Abstract
Genetic alterations in human cancers and murine models indicate that Rb and p53 have critical tumor suppressive functions in retinoblastoma, a tumor of neural origin, and neuroendocrine tumors including small cell lung cancer and medullary thyroid cancer (MTC). Rb inactivation is the initiating lesion in retinoblastoma and current models propose that induction of apoptosis is a key p53 tumor suppressive function. Genetic studies in mice, however, indicate that other undefined p53 tumor suppressive functions are operative in vivo. How p53 loss cooperates with Rb inactivation to promote carcinogenesis is also not fully understood. In the current study, genetically engineered mice were generated to determine the role of Rb and p53 in MTC pathogenesis and test the hypothesis that p53 suppresses carcinogenesis by inhibiting mTOR signaling. Conditional Rb ablation resulted in thyroid tumors mimicking human MTC, and additional p53 loss led to rapid tumor progression. p53 suppressed tumorigenesis by inhibiting cell cycle progression, but did not induce apoptosis. On the contrary, p53 loss led to increased apoptosis that had to be overcome for tumor progression. mTOR activity was markedly increased in p53 deficient tumors and rapamycin treatment suppressed tumor cell growth identifying mTOR inhibition as a critical p53 tumor suppressive function. Rapamycin treatment did not result in AKT/MAPK activation providing evidence that this feedback mechanism operative in other cancers is not a general response to mTORC1 inhibition. Together, these studies provide mechanistic links between genetic alterations and aberrant signaling pathways critical in carcinogenesis, and identify essential Rb and p53 tumor suppressive functions in vivo.
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Affiliation(s)
- N Akeno
- Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A L Miller
- Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - X Ma
- Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K A Wikenheiser-Brokamp
- 1] Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA [2] Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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20
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Abstract
Medullary thyroid carcinoma (MTC) accounts for only 5% to 10% of all thyroid carcinomas, but it is the most aggressive form of well-differentiated thyroid carcinoma, being responsible for 8% to 15% of all thyroid cancer-related deaths. MTC is frequently diagnosed at a locally advanced or metastatic stage, and 10-year survival rates in these cases are <20%. Fine-needle aspiration biopsy of the thyroid gland is an accurate method to diagnose MTC, having a high sensitivity and specificity. The cytologic features of MTC are characteristic and the cytologic diagnosis of classic MTC is often straightforward, especially when combined with immunocytochemistry. However, because of its morphologic heterogeneity and overlap with other tumors, the differential diagnosis of MTC on cytology and on histology is broad with several potential pitfalls. Significant advances have been made over the last decade in understanding MTC. This concerns mainly the early detection of MTC, especially in familial forms (eg, multiple endocrine neoplasia type 2), and the identification of key molecular pathways and alterations which now offer promising targets for specific therapies in progressive MTC cases. Genetic testing (eg, RET mutation) has allowed for early detection in asymptomatic carriers and high-risk patients, with prophylactic thyroidectomy often being curative. Targeted therapies with multityrosine-kinase inhibitors (eg, vandetanib or cabozantinib) have emerged as promising new treatments for recurrent or metastatic MTC. In this review article, we discuss the cytologic features of MTC and its variants, its differential diagnosis, the role of ancillary studies, and the salient molecular features of MTC.
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21
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Zámečníkova A. Novel approaches to the development of tyrosine kinase inhibitors and their role in the fight against cancer. Expert Opin Drug Discov 2013; 9:77-92. [DOI: 10.1517/17460441.2014.865012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Medullary thyroid cancer (MTC) typically accounts for 3%-4% of all thyroid cancers. Although the majority of MTCs are sporadic, 20% of cases are hereditary. Hereditary MTC can be found in multiple endocrine neoplasia 2A or 2B or as part of familial MTC based on a specific germline mutation in the RET proto-oncogene. This article discusses the current approaches available for the diagnosis, evaluation, and management of patients and their family members with suspected MTC. The disease is predominantly managed surgically and typically requires a total thyroidectomy and lymph node dissection. A review of recent guidelines on the extent and timing of surgical excision is discussed. There are not very many effective systemic treatment options for MTC, but several emerging therapeutic targets have promise.
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Affiliation(s)
- Madhuchhanda Roy
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Abstract
In recent years, our understanding of the genetic alterations underlying thyroid oncogenesis has greatly expanded. The use of molecular markers, including RAS, in the management of thyroid carcinoma is also increasing. This review summarizes the current literature surrounding RAS and discusses its potential as a diagnostic and prognostic indicator in the management of thyroid cancer.
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Affiliation(s)
- Gina M Howell
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Pazaitou-Panayiotou K, Chrisoulidou A, Mandanas S, Tziomalos K, Doumala E, Patakiouta F. Predictive factors that influence the course of medullary thyroid carcinoma. Int J Clin Oncol 2013; 19:445-51. [DOI: 10.1007/s10147-013-0588-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/11/2013] [Indexed: 01/31/2023]
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25
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Zhang B, Xu ZW, Wang KH, Lu TC, Du Y. Complex Regulatory Network of MicroRNAs, Transcription Factors, Gene Alterations in Adrenocortical Cancer. Asian Pac J Cancer Prev 2013; 14:2265-8. [DOI: 10.7314/apjcp.2013.14.4.2265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Medullary thyroid cancers (MTC) are rare neuroendocrine tumors arising from the parafollicular C-cells of the thyroid. In this review, we provide a general overview of the classification, pathology, and clinical management of MTC. In the latter half, we survey the underlying genetic framework of MTC and its potential implications within a diagnostic and therapeutic context.
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Affiliation(s)
- Yash R Somnay
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, K3/704 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA (YS, DS, HM)
| | - David Schneider
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, K3/704 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA (YS, DS, HM)
| | - Haggi Mazeh
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, K3/704 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA (YS, DS, HM)
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27
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Current world literature. Curr Opin Oncol 2012; 24:756-68. [PMID: 23079785 DOI: 10.1097/cco.0b013e32835a4c91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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