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Weber M, Kersting D, Riemann B, Brandenburg T, Führer-Sakel D, Grünwald F, Kreissl MC, Dralle H, Weber F, Schmid KW, Herrmann K, Jentzen W, Grafe H, Rischpler C, Theurer S, Bockisch A, Nagarajah J, Fendler WP. Enhancing Radioiodine Incorporation into Radioiodine-Refractory Thyroid Cancer with MAPK Inhibition (ERRITI): A Single-Center Prospective Two-Arm Study. Clin Cancer Res 2022; 28:4194-4202. [PMID: 35594174 PMCID: PMC9527501 DOI: 10.1158/1078-0432.ccr-22-0437] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Restoration of iodine incorporation (redifferentiation) by MAPK inhibition was achieved in previously radioiodine-refractory, unresectable thyroid carcinoma (RR-TC). However, results were unsatisfactory in BRAFV600E-mutant (BRAF-MUT) RR-TC. Here we assess safety and efficacy of redifferentiation therapy through genotype-guided MAPK-modulation in patients with BRAF-MUT or wildtype (BRAF-WT) RR-TC. PATIENTS AND METHODS In this prospective single-center, two-arm phase II study, patients received trametinib (BRAF-WT) or trametinib + dabrafenib (BRAF-MUT) for 21 ± 3 days. Redifferentiation was assessed by 123I-scintigraphy. In case of restored radioiodine uptake, 124I-guided 131I therapy was performed. Primary endpoint was the redifferentiation rate. Secondary endpoints were treatment response (thyroglobulin, RECIST 1.1) and safety. Parameters predicting successful redifferentiation were assessed using a receiver operating characteristic analysis and Youden J statistic. RESULTS Redifferentiation was achieved in 7 of 20 (35%) patients, 2 of 6 (33%) in the BRAF-MUT and 5 of 14 (36%) in the BRAF-WT arm. Patients received a mean (range) activity of 300.0 (273.0-421.6) mCi for 131I therapy. Any thyroglobulin decline was seen in 57% (4/7) of the patients, RECIST 1.1 stable/partial response/progressive disease in 71% (5/7)/14% (1/7)/14% (1/7). Peak standardized uptake value (SUVpeak) < 10 on 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET was associated with successful redifferentiation (P = 0.01). Transient pyrexia (grade 3) and rash (grade 4) were noted in one patient each. CONCLUSIONS Genotype-guided MAPK inhibition was safe and resulted in successful redifferentiation in about one third of patients in each arm. Subsequent 131I therapy led to a thyroglobulin (Tg) decline in more than half of the treated patients. Low tumor glycolytic rate as assessed by FDG-PET is predictive of redifferentiation success. See related commentary by Cabanillas et al., p. 4164.
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Affiliation(s)
- Manuel Weber
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Corresponding Author: Manuel Weber, German Cancer Consortium (DKTK) partner site Essen, Hufelandstraße 55, 45147 Essen, Germany. Phone: 49-201-723-2032; Fax: 49-201-723-5658; E-mail:
| | - David Kersting
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Burkhard Riemann
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany
| | - Tim Brandenburg
- German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- German Cancer Consortium (DKTK) partner site Essen, Essen, Germany.,Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Michael C. Kreissl
- Clinic of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Walter Jentzen
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Hong Grafe
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Christoph Rischpler
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Bockisch
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
| | - James Nagarajah
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wolfgang P. Fendler
- Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) partner site Essen, Essen, Germany
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Personalized Dosimetry in the Context of Radioiodine Therapy for Differentiated Thyroid Cancer. Diagnostics (Basel) 2022; 12:diagnostics12071763. [PMID: 35885666 PMCID: PMC9320760 DOI: 10.3390/diagnostics12071763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
The most frequent thyroid cancer is Differentiated Thyroid Cancer (DTC) representing more than 95% of cases. A suitable choice for the treatment of DTC is the systemic administration of 131-sodium or potassium iodide. It is an effective tool used for the irradiation of thyroid remnants, microscopic DTC, other nonresectable or incompletely resectable DTC, or all the cited purposes. Dosimetry represents a valid tool that permits a tailored therapy to be obtained, sparing healthy tissue and so minimizing potential damages to at-risk organs. Absorbed dose represents a reliable indicator of biological response due to its correlation to tissue irradiation effects. The present paper aims to focus attention on iodine therapy for DTC treatment and has developed due to the urgent need for standardization in procedures, since no unique approaches are available. This review aims to summarize new proposals for a dosimetry-based therapy and so explore new alternatives that could provide the possibility to achieve more tailored therapies, minimizing the possible side effects of radioiodine therapy for Differentiated Thyroid Cancer.
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Campennì A, Barbaro D, Guzzo M, Capoccetti F, Giovanella L. Personalized management of differentiated thyroid cancer in real life - practical guidance from a multidisciplinary panel of experts. Endocrine 2020; 70:280-291. [PMID: 32772339 PMCID: PMC7581611 DOI: 10.1007/s12020-020-02418-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. METHODS A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. RESULTS We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. CONCLUSIONS In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | | | - Marco Guzzo
- Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Capoccetti
- Service Department Macerata Hospital, ASUR Marche AV3, Nuclear Medicine Unit, Macerata, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Kaewput C, Pusuwan P. Outcomes following I-131 treatment with cumulative dose exceeding or equal to 600 mCi in differentiated thyroid carcinoma patients. World J Nucl Med 2020; 20:54-60. [PMID: 33850490 PMCID: PMC8034781 DOI: 10.4103/wjnm.wjnm_49_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022] Open
Abstract
To evaluate treatment outcomes following radioactive iodine (RAI) treatment with a cumulative dose of ≥≥600 mCi in differentiated thyroid carcinoma (DTC) patients, a retrospective review of medical records was done in 176 DTC patients with a cumulative dose of ≥600 mCi from January 1993 to December 2013. All patients were followed up for at least 2 years after receiving 600 mCi of I-131 treatment. Remission criteria were no clinical and imaging evidence of disease and low serum thyroglobulin levels during thyroid-stimulating hormone suppression of <0.2 ng/ml or of <1 ng/ml after stimulation in the absence of interfering antibodies. A total of 176 patients were included in the study: 137 - papillary thyroid cancer, 29 - follicular thyroid cancer, 9 - mixed papillary and follicular thyroid cancer, and 1 - Hurthle cell carcinoma. Most of the patients (118, 67%) had locoregional metastasis, whereas 48 patients (27%) had distant metastases at presentation. The median cumulative dose was 900 mCi (range: 600-2200 mCi). The mean follow-up period was 82.84 ± 42.41 months. Only 16 patients (9.1%) met remission criteria at the end of treatment. The rest of patients (160, 90.9%) were not remitted: stable disease in 94 (53.4%), at least 1 metastasis without I-131 uptake in 34 (19.3%), progressive disease in 21 (11.9%), and death during the whole follow-up period in 11 (6.3%). Two patients (1.1%) developed second primary malignancy. Eighteen cases were suspected of bone marrow suppression (14 cases [7.9%] had anemia and 5 cases [2.8%] had neutropenia). Seven patients (3.9%) developed permanent salivary gland dysfunction. Although the complications after receiving RAI treatment with a cumulative dose of ≥≥600 mCi were low and not severe, the patients with remission were in <10%. Our study suggests that the decision to administer further treatments should be made on an individual basis because beneficial effects may be controversial.
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Affiliation(s)
- Chalermrat Kaewput
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawana Pusuwan
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yang J, Zheng R, Liang M, Jia Y, Lin L, Geng J, Chen S, Li YX. Association of the Cumulative Dose of Radioactive Iodine Therapy With Overall Survival in Patients With Differentiated Thyroid Cancer and Pulmonary Metastases. Front Oncol 2019; 9:558. [PMID: 31316914 PMCID: PMC6609903 DOI: 10.3389/fonc.2019.00558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/07/2019] [Indexed: 01/06/2023] Open
Abstract
Purpose: The optimal cumulative dose of radioactive iodine therapy (RAIT) for patients with differentiated thyroid cancer (DTC) and pulmonary metastases (PM) is not known, therefore we evaluated the association between the cumulative dose of RAIT and overall survival (OS). Methods: A total of 202 patients with DTC and PM who underwent thyroidectomy and RAIT were analyzed in this study. The median cumulative dose of RAIT was 530 mCi. OS was compared with an age- and sex-matched general population from China to assess relative survival. Multivariable proportional hazards model smoothing by penalized spline was applied to identify independent predictors and examine the adjusted non-linear association of cumulative dose of RAIT and patient age with mortality. Results: The observed survival and relative survival at 10 years was 54.96 and 60.81%, respectively, with the standardized mortality ratio being 5.34. The cumulative dose of RAIT was associated with mortality in a dose-dependent fashion without an apparent cutoff point after adjustment of other variables. A linear but moderate association was found in the dose of 300 to 1,000 mCi. Cumulative dose of RAIT, patient age, diameter of pulmonary metastases, and extrapulmonary metastases were identified as independent predictors for OS. The increasing patient age was associated with mortality in a non-linear pattern, with the optimal threshold being 40 years. With advancing age, the risk of death increases rapidly in patients aged 40 years and younger, but slowly in patients over 40 years. Conclusions: RAIT should be assigned to RAI-avid patients until disease has been controlled or RAIT becomes refractory after consideration of the potential long-term side-effects. Patient age was associated with OS in a non-linear pattern, with a threshold at 40 years. Consideration of age as a binary variable could elucidate a more accurate prognosis in such patients.
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Affiliation(s)
- Jing Yang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Zheng
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Liang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Jia
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Lin
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Geng
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengzu Chen
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Rosário PW, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, Maia AL, Vaisman M. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. ACTA ACUST UNITED AC 2013; 57:240-64. [DOI: 10.1590/s0004-27302013000400002] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Indexed: 12/11/2022]
Abstract
Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.
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Affiliation(s)
| | | | | | - Hans Graf
- Universidade Federal do Paraná, Brazil
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