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Arslan IE, Bostan H, Hepşen S, Akhanli P, Sencar ME, Cakal E. Evaluation of the Malignancy Risk in Nodules Expanding the Thyroid Gland Capsule. Horm Metab Res 2024. [PMID: 38942051 DOI: 10.1055/a-2356-8223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
There has been an increase in the diagnosis of thyroid nodules in recent years. In addition to the well-known criteria, features that are likely to increase the risk of malignancy are in the research process. In this study, we aimed to evaluate the malignant potential of nodules that expand the thyroid capsule ultrasonographically. A total of 109 patients with thyroid capsule-expanding nodules and 288 patients with non-expanding nodules were included in the study. Demographical data, ultrasonography features, and cytology results were noted, and histopathological findings were determined in operated patients. While malignant cytology was detected in 5.5% of capsule-expanding nodules in FNAB results, this rate was 0.7% in the non-capsule expanding group (p<0.001). According to the histopathological results, the incidence of malignancy was 15.6% in the capsule-expanding nodule group, while it was 3.1% in the other group (p=0.001). As a result of logistic regression analysis, it was determined that the risk of malignancy increased by 4.44-fold (95% CI 1.4-13.8, p=0.01) in patients with capsule-expanding nodules. Other features that increased the risk of malignancy were hypoechogenicity, microcalcification, and irregular margin presence. In this study, we found that the risk of malignancy increased in nodules expanding the thyroid capsule. Based on the increasing study data on this subject, monitoring thyroid capsule expansion in nodules may take its place among the criteria for malignancy in future evaluations.
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Affiliation(s)
- Ismail Emre Arslan
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - Hayri Bostan
- Endocrinology and Metabolism, Ministry of Health Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Sema Hepşen
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - Pinar Akhanli
- Endocrinology and Metabolism, Erzurum Bölge Eğitim ve Araştırma Hastanesi, Erzurum, Turkey
| | - Muhammed Erkam Sencar
- Endocrinology and Metabolism, Medicana International Ankara Hospital, Ankara, Turkey
| | - Erman Cakal
- Endocrinology and Metabolism, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
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Ferrari SM, Ragusa F, Elia G, Mazzi V, Balestri E, Botrini C, Rugani L, Patrizio A, Piaggi S, La Motta C, Ulisse S, Virili C, Antonelli A, Fallahi P. Antineoplastic Effect of ALK Inhibitor Crizotinib in Primary Human Anaplastic Thyroid Cancer Cells with STRN-ALK Fusion In Vitro. Int J Mol Sci 2024; 25:6734. [PMID: 38928438 PMCID: PMC11203609 DOI: 10.3390/ijms25126734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Anaplastic thyroid cancer (ATC) is one of the deadliest human cancers and represents <2% of thyroid carcinomas. A therapeutic target for ATC is represented by anaplastic lymphoma kinase (ALK) rearrangements, involved in tumor growth. Crizotinib is an oral small-molecule tyrosine kinase inhibitor of the ALK, MET, and ROS1 kinases, approved in ALK-positive non-small cell lung cancer. Until now, the effect of crizotinib in "primary human ATC cells" (pATCs) with transforming striatin (STRN)-ALK fusion has not been reported in the literature. In this study, we aimed to obtain pATCs with STRN-ALK in vitro and evaluate the in vitro antineoplastic action of crizotinib. Thyroid surgical samples were obtained from 12 ATC patients and 6 controls (who had undergone parathyroidectomy). A total of 10/12 pATC cultures were obtained, 2 of which with transforming STRN-ALK fusion (17%). Crizotinib inhibited proliferation, migration, and invasion and increased apoptosis in 3/10 pATC cultures (2 of which with/1 without STRN-ALK), particularly in those with STRN-ALK. Moreover, crizotinib significantly inhibited the proliferation of AF cells (a continuous cell line obtained from primary ATC cells). In conclusion, the antineoplastic activity of crizotinib has been shown in human pATCs (with STRN-ALK) in preclinical studies in vitro, opening the way to future clinical evaluation in these patients.
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Affiliation(s)
| | - Francesca Ragusa
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Giusy Elia
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Valeria Mazzi
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Eugenia Balestri
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Chiara Botrini
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Licia Rugani
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Simona Piaggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.P.); (P.F.)
| | | | - Salvatore Ulisse
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Endocrinology Section, “Sapienza” University of Rome, 04100 Latina, Italy;
| | - Alessandro Antonelli
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (V.M.); (E.B.); (C.B.); (L.R.); (A.A.)
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (S.P.); (P.F.)
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Molecular Aspects and Therapeutic Implications of Herbal Compounds Targeting Different Types of Cancer. MOLECULES (BASEL, SWITZERLAND) 2023; 28:molecules28020750. [PMID: 36677808 PMCID: PMC9867434 DOI: 10.3390/molecules28020750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
Due to genetic changes in DNA (deoxyribonucleic acid) sequences, cancer continues to be the second most prevalent cause of death. The traditional target-directed approach, which is confronted with the importance of target function in healthy cells, is one of the most significant challenges in anticancer research. Another problem with cancer cells is that they experience various mutations, changes in gene duplication, and chromosomal abnormalities, all of which have a direct influence on the potency of anticancer drugs at different developmental stages. All of these factors combine to make cancer medication development difficult, with low clinical licensure success rates when compared to other therapy categories. The current review focuses on the pathophysiology and molecular aspects of common cancer types. Currently, the available chemotherapeutic drugs, also known as combination chemotherapy, are associated with numerous adverse effects, resulting in the search for herbal-based alternatives that attenuate resistance due to cancer therapy and exert chemo-protective actions. To provide new insights, this review updated the list of key compounds that may enhance the efficacy of cancer treatment.
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Al-Abdallah A, Jahanbani I, Ali RH, Al-Brahim N, Prasanth J, Al-Shammary B, Al-Bader M. A new paradigm for epidermal growth factor receptor expression exists in PTC and NIFTP regulated by microRNAs. Front Oncol 2023; 13:1080008. [PMID: 37114127 PMCID: PMC10126268 DOI: 10.3389/fonc.2023.1080008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Intoduction Identification of molecular alterations associated with tumor behavior is necessary to guide clinical management. The 2022 WHO classification has organized the thyroid follicular cell-derived neoplasms into benign, low-risk and high-risk neoplasms, and emphasized the value of biomarkers that may provide differential diagnostic and prognostic information to avoid overtreatment of low risk neoplasms. This work aims to study the epidermal growth factor receptor (EGFR) expression, functional and spatial dynamics in relation to specific miRNAs alterations in papillary thyroid cancer (PTC) and in non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) considered as models of high-risk and low-risk thyroid tumors respectively. Methods Primary thyroid cultured cells were used for miRNA gain/loss of function and luciferase reporter assays. Paraffin embedded tissues were used for real time PCR, immuno-fluorescence stain and confocal microscopy experiments. Results Our results showed that in PTC, EGFR mRNA is reduced as an effect of miR-146b-5p upregulation. The EGF expression is low and the ERK pathway is inhibited. The EGFR protein high cytoplasmic expression and colocalization with the endosomal/exosomal markers, ALIX and CD63, suggest the occurrence of stress-induced EGFR internalization, accumulation in endosomal vesicles and secretion via exosomes. In NIFTP EGFR transcription is increased in association with downregulation of miR-7-5p and the EGFR/ERK pathway is active indicating dependence on the canonical EGFR pathway for growth. Conclusion Downregulation of transcript level along with cytoplasmic accumulation of undegraded protein is a new pattern of EGFR regulation associated with malignancy in thyroid. Further research is needed to elucidate the intracellular trafficking defects responsible for this specific EGFR dynamic in PTC.
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Affiliation(s)
- Abeer Al-Abdallah
- Pathology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
- *Correspondence: Abeer Al-Abdallah,
| | - Iman Jahanbani
- Pathology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
| | - Rola H. Ali
- Pathology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
| | | | - Jeena Prasanth
- Pathology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
| | - Bashayer Al-Shammary
- Pathology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
| | - Maie Al-Bader
- Physiology Department, Kuwait University, Faculty of Medicine, Kuwait City, Kuwait
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5
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Li Y, Luo Z, Wang X, Zhang S, Hei H, Qin J. Design of new drugs for medullary thyroid carcinoma. Front Oncol 2022; 12:993725. [PMID: 36544713 PMCID: PMC9760674 DOI: 10.3389/fonc.2022.993725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/18/2022] [Indexed: 12/08/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is one of the common malignant endocrine tumors, which seriously affects human health. Although surgical resection offers a potentially curative therapeutic option to some MTC patients, most patients do not benefit from it due to the difficulty to access the tumors and tumor metastasis. The survival rate of MTC patients has improved with the recent advances in the research, which has improved our understanding of the molecular mechanism underlying MTC and enabled the development and approval of novel targeted drugs. In this article, we reviewed the molecular mechanisms related to MTC progression and the principle for the design of molecular targeted drugs, and proposed some future directions for prospective studies exploring targeted drugs for MTC.
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Affiliation(s)
- Yanqing Li
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China,The Medical School of Zhengzhou University, Zhengzhou, China
| | - Ziyu Luo
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China,The Medical School of Zhengzhou University, Zhengzhou, China
| | - Xinxing Wang
- Department of Pain and Rehabilitation and Palliative Medicine, Henan Cancer Hospital, Zhengzhou, China,*Correspondence: Songtao Zhang, ; Hu Hei, ; Jianwu Qin, ; Xinxing Wang,
| | - Songtao Zhang
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China,The Medical School of Zhengzhou University, Zhengzhou, China,*Correspondence: Songtao Zhang, ; Hu Hei, ; Jianwu Qin, ; Xinxing Wang,
| | - Hu Hei
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China,The Medical School of Zhengzhou University, Zhengzhou, China,*Correspondence: Songtao Zhang, ; Hu Hei, ; Jianwu Qin, ; Xinxing Wang,
| | - Jianwu Qin
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China,The Medical School of Zhengzhou University, Zhengzhou, China,*Correspondence: Songtao Zhang, ; Hu Hei, ; Jianwu Qin, ; Xinxing Wang,
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6
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Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, Campbell M, Dickson P, Duh QY, Ehya H, Goldner WS, Guo T, Haymart M, Holt S, Hunt JP, Iagaru A, Kandeel F, Lamonica DM, Mandel S, Markovina S, McIver B, Raeburn CD, Rezaee R, Ridge JA, Roth MY, Scheri RP, Shah JP, Sipos JA, Sippel R, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Yeh M, Cassara CJ, Darlow S. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:925-951. [PMID: 35948029 DOI: 10.6004/jnccn.2022.0040] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable. Anaplastic thyroid carcinoma is almost uniformly lethal, and iodine-131 imaging and radioactive iodine cannot be used. When systemic therapy is indicated, targeted therapy options are preferred. This article describes NCCN recommendations regarding management of medullary thyroid carcinoma and anaplastic thyroid carcinoma, and surgical management of differentiated thyroid carcinoma (papillary, follicular, Hürthle cell carcinoma).
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Affiliation(s)
| | | | - Douglas Ball
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Paxton Dickson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Quan-Yang Duh
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Shelby Holt
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Jason P Hunt
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Susan Mandel
- Abramson Cancer Center at the University of Pennsylvania
| | - Stephanie Markovina
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Rod Rezaee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Mara Y Roth
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Jennifer A Sipos
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Cord Sturgeon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Michael Yeh
- UCLA Jonsson Comprehensive Cancer Center; and
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Lieberman L, Worden F. Novel Therapeutics for Advanced Differentiated Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:367-378. [PMID: 35662446 DOI: 10.1016/j.ecl.2021.11.019] [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] [Indexed: 11/17/2022]
Abstract
The current treatments for radioactive iodine (RAI) -refractory differentiated thyroid cancer (DTC) are evolving as cancer genomics are further understood. Multitargeted tyrosine kinase inhibitors are the first-line therapy for symptomatic or progressive disease; however, considerable adverse effects have spurred the development of targeted therapies for redifferentiation of iodine avidity and the treatment of RAI-refractory DTC. Next-generation sequencing allows for the use of tumor-targeted therapeutics, such as MEK1/2, BRAF, RET, and NTRK inhibitors. Immunotherapy is also under investigation as a therapeutic option for this disease.
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Affiliation(s)
- Leedor Lieberman
- Department of Metabolism, Endocrinology and Diabetes, University of Michigan, Lobby C #1300, 4029 Avenue Maria Drive, Ann Arbor, MI 48105, USA
| | - Francis Worden
- Department of Hematology and Oncology, University of Michigan, 1500 East Medical Center Drive Med Inn Building, Room C369, Ann Arbor, MI 48109, USA.
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Ragusa F, Ferrari SM, Elia G, Paparo SR, Balestri E, Botrini C, Patrizio A, Mazzi V, Guglielmi G, Foddis R, Spinelli C, Ulisse S, Antonelli A, Fallahi P. Combination Strategies Involving Immune Checkpoint Inhibitors and Tyrosine Kinase or BRAF Inhibitors in Aggressive Thyroid Cancer. Int J Mol Sci 2022; 23:ijms23105731. [PMID: 35628540 PMCID: PMC9144613 DOI: 10.3390/ijms23105731] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Thyroid cancer is the most common (~90%) type of endocrine-system tumor, accounting for 70% of the deaths from endocrine cancers. In the last years, the high-throughput genomics has been able to identify pathways/molecular targets involved in survival and tumor progression. Targeted therapy and immunotherapy individually have many limitations. Regarding the first one, although it greatly reduces the size of the cancer, clinical responses are generally transient and often lead to cancer relapse after initial treatment. For the second one, although it induces longer-lasting responses in cancer patients than targeted therapy, its response rate is lower. The individual limitations of these two different types of therapies can be overcome by combining them. Here, we discuss MAPK pathway inhibitors, i.e., BRAF and MEK inhibitors, combined with checkpoint inhibitors targeting PD-1, PD-L1, and CTLA-4. Several mutations make tumors resistant to treatments. Therefore, more studies are needed to investigate the patient's individual tumor mutation burden in order to overcome the problem of resistance to therapy and to develop new combination therapies.
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Affiliation(s)
- Francesca Ragusa
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Sabrina Rosaria Paparo
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Eugenia Balestri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Chiara Botrini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy;
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Giovanni Guglielmi
- U.O. Medicina Preventiva Del Lavoro, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy;
| | - Rudy Foddis
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.F.); (P.F.)
| | - Claudio Spinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
| | - Salvatore Ulisse
- Department of Surgical Sciences, ‘Sapienza’ University of Rome, 00161 Rome, Italy;
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (F.R.); (G.E.); (S.R.P.); (E.B.); (C.B.); (V.M.); (C.S.)
- Correspondence: ; Tel.: +39-050-992318
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.F.); (P.F.)
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Elia G, Ferrari SM, Ragusa F, Paparo SR, Mazzi V, Ulisse S, Benvenga S, Antonelli A, Fallahi P. Advances in pharmacotherapy for advanced thyroid cancer of follicular origin (PTC, FTC). New approved drugs and future therapies. Expert Opin Pharmacother 2022; 23:599-610. [PMID: 35038965 DOI: 10.1080/14656566.2022.2030704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The most common altered signaling found in aggressive iodine-refractory Thyroid cancer derived from follicular cells (RAI-TC) are RTK, MAPK, PI3K, WNT, BRAF, RAS, RET, and TP53. Tyrosine Kinase Inhibitors (TKI) are multi-kinase inhibitors able to act against different pathways, that elicit an anti-neoplastic activity. AREAS COVERED The aim of this paper is to review recent novel molecular therapies of RAI-TC. Recently, sorafenib and lenvatinib, have been approved for the treatment of aggressive RAI-TC. Other studies are evaluating vandetanib and selumetinib in RAI-TC. Furthermore, preliminary studies have evaluated dabrafenib, and vemurafenib in BRAF mutated RAI-TC patients to re-induce 131-iodine uptake. The interplay between cells of the immune system and cancer cells can be altered by immune checkpoints inhibitors. The expression of PDL1 in RAI-TC was related to tumor recurrence and poor survival. Several clinical trials are investigating a combination of different therapies, such as lenvatinib and pembrolizumab. EXPERT OPINION Mechanisms of resistance to TKIs inhibitors can be of intrinsic or acquired origin. An acquired resistance to lenvatinib, or sorafenib can be due to upregulation of FGFR; therefore anti-FGFR agents are evaluated. A new strategy is to combine TKIs with immunotherapy. Several studies are evaluating lenvatinib and pembrolizumab in RAI-TC patients.
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Affiliation(s)
- Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular and Clinical Endocrinology and Women's Endocrine Health, Azienda Ospedaliera Universitaria Policlinico 'G. Martino', I-98125, Messina, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Noncoding RNAs in Papillary Thyroid Cancer: Interaction with Cancer-Associated Fibroblasts (CAFs) in the Tumor Microenvironment (TME) and Regulators of Differentiation and Lymph Node Metastasis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1350:145-155. [PMID: 34888848 DOI: 10.1007/978-3-030-83282-7_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A large majority of all thyroid cancers are papillary thyroid carcinomas (PTC), named for the specific papillary architecture observed histologically. Despite the high rate of success with modern diagnostic and therapeutic algorithms, there are significant areas where the management of PTC can be improved. Aggressive PTC subtypes that are refractory to radioactive iodine (RAI) therapy carry a more severe prognosis and account for most of PTC-related deaths. As lymph node metastasis is present in roughly 40% of all adult PTC cases, higher specificity in these tests is a clinical need, especially since lymph node metastases are associated with reduced survival and higher recurrence rates. Additionally, this cancer can progress to more dedifferentiated and aggressive variants, such as poorly differentiated papillary thyroid cancer (PDPTC) and anaplastic thyroid cancer (ATC). Therefore, development of more sensitive and specific detection methods that allow unnecessary surgeries to be avoided is of the utmost importance. The body of large-scale, unbiased gene expression analysis in PTC has focused on the coding transcriptome, specifically mRNAs and microRNAs. However, there have been implications for the potential use of long noncoding RNAs (lncRNAs) in PTC diagnosis, prognosis, and treatment via the utilization of genome-wide studies of patient samples. lncRNAs have diverse regulatory potential in gene expression, alternative splicing, posttranscriptional mRNA modification, and epigenomic alterations. Many lncRNAs have tissue-specific expression and are demonstrated to play key roles in cancer progression and prognosis. However, lncRNAs are not being exploited as biomarkers or therapeutic targets currently, despite their elucidated effects on oncogenesis. These potent biomarkers would be revolutionary in detection at early stages, as this significantly increases the chances of survival. Their aberrant expression in cancer and correlation with steps in tumorigenesis as well as their role in differentiation would allow for a promising role as a prognostic and diagnostic biomarker in thyroid cancer. This would help prevent the more aggressive ATC that derives from dedifferentiation of the less aggressive PTC and FTC. The targeting of the specific lncRNAs could also pose a valuable treatment option via preventing or reversing this dedifferentiation process and making this usually refractory form of thyroid cancer more responsive to standard treatment options.
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Persichetti A, Monti S, Coccaro C, Presciuttini F, Deiana MG, Bizzarri G, Bianchini A, Triggiani V, Papini E, Guglielmi R. Combined Treatment with Laser Ablation and Tyrosine-Kinase Inhibitor as a Novel Multimodality Approach to Locally Advanced Thyroid Cancer: a Case Report. Endocr Metab Immune Disord Drug Targets 2021; 22:357-362. [PMID: 34459381 DOI: 10.2174/1871530321666210830093522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/10/2021] [Accepted: 07/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Direct locoregional treatments were recently proposed for the local control of cervical and distant metastasis of thyroid cancer, but data on their use as part of a multimodality approach for primary thyroid tumors are poor. In this feasibility study, laser ablation (LTA) was successfully used for the initial debulking of unresectable radioiodine-refractory thyroid cancer in sequential therapy with tyrosine-kinase inhibitors (TKI). CLINICAL CASE A 69-year-old woman underwent partial resection of papillary thyroid cancer with extensive tracheal infiltration. Post-treatment whole-body scan (131I, 8140 MBq) showed the absence of cervical thyroid uptake. The patient experienced a rapid increase in her cervical mass associated with dysphonia, dyspnea, and dysphagia. Due to a concomitant severe hypertensive state and cardiac failure, the patient was treated with LTA after a multidisciplinary consultation. After local anesthesia, two 300 nm optic fibers were inserted into the lesion through 21G spinal needles. Two illuminations with 4-watt output power and 3600 Joules energy delivery were performed with a diode-laser source. LTA resulted in rapid cancer debulking, and mass volume decreased from 23.9 to 7.5 mL resulting in significant improvement of pressure symptoms. Three months later, the patient was started on lenvatinib due to the initial regrowth of the tumor mass. The cervical tumor burden was controlled by TKI for 20 months when a rapid disease progression occurred, and the patient died. DISCUSSION Locally advanced, unresectable, and radioiodine-refractory thyroid tumors can be managed with a novel multimodality approach. The initial debulking with LTA of the locally aggressive disease results in rapid control of the tumor burden threatening patients' life and is effectively followed by long-term control with TKI treatment. CONCLUSION Based on this experience, sequential multimodality treatment with an initial locally directed laser ablation procedure followed by TKI therapy may be considered as a salvage option in patients with unresectable and rapidly progressive RR thyroid tumors.
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Affiliation(s)
- Agnese Persichetti
- Department of Endocrinology & Metabolism, Regina Apostolorum Hospital, Rome. Italy
| | - Salvatore Monti
- Endocrinology Department, Sant' Andrea Hospital, Rome. Italy
| | - Carmela Coccaro
- Civil disability, National Social Welfare Institution, Rome. Italy
| | | | | | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Regina Apostolorum Hospital, Rome. Italy
| | - Antonio Bianchini
- Department of Diagnostic Imaging, Regina Apostolorum Hospital, Rome. Italy
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases-Interdisciplinary Department of Medicine, University of Bari "A. Moro", Bari. Italy
| | - Enrico Papini
- Department of Endocrinology & Metabolism, Regina Apostolorum Hospital, Rome. Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology & Metabolism, Regina Apostolorum Hospital, Rome, Italy; 2 Department of Diagnostic Imaging, Regina Apostolorum Hospital, Rome, Italy; 3 Endocrinology Department, Sant' Andrea Hospital, Rome. Italy
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12
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Ferrari SM, Elia G, Ragusa F, Paparo SR, Mazzi V, Miccoli M, Galdiero MR, Varricchi G, Foddis R, Guglielmi G, Spinelli C, La Motta C, Benvenga S, Antonelli A, Fallahi P. Lenvatinib: an investigational agent for the treatment of differentiated thyroid cancer. Expert Opin Investig Drugs 2021; 30:913-921. [PMID: 34428101 DOI: 10.1080/13543784.2021.1972971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Differentiated thyroid cancer (DTC; >90% of all TCs) derives from follicular cells. Surgery is the main therapeutic strategy, and radioiodine (RAI) is administered after thyroidectomy. When DTC progresses, it does not respond to RAI and thyroid-stimulating hormone (TSH)-suppressive thyroid hormone treatment, and other therapies (i.e. surgery, external beam radiation therapy and chemotherapy) do not lead to a better survival. Thanks to the understanding of the molecular pathways involved in TC progression, important advances have been done. Lenvatinib is a multitargeted tyrosine kinase inhibitor of VEGFR1-3, FGFR1-4, PDGFRα, RET, and KIT signaling networks implicated in tumor angiogenesis, approved in locally recurrent or metastatic, progressive, RAI-refractory DTC. Unmet needs regarding the patient clinical therapy responsiveness in aggressive RAI-refractory DTC still remain. AREAS COVERED We provide an overview from the literature of in vitro, in vivo and real-life studies regarding lenvatinib as an investigational agent for the treatment of aggressive TC. EXPERT OPINION According to the SELECT trial, the treatment should be initiated with a dosage of 24 mg/day, subsequently decreasing it in relation to the side effects. The decision making process in patients with aggressive RAI-refractory DTC should be personalized and the potential toxicity should be properly managed.
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Affiliation(s)
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Rosaria Galdiero
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy; WAO Center of Excellence, Naples, Italy; Institute of Experimental Endocrinology and Oncology "G. Salvatore" (IEOS), National Research Council (CNR),Naples, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy; WAO Center of Excellence, Naples, Italy; Institute of Experimental Endocrinology and Oncology "G. Salvatore" (IEOS), National Research Council (CNR),Naples, Italy
| | - Rudy Foddis
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Guglielmi
- U.O. Medicina Preventiva Del Lavoro, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Claudio Spinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular and Clinical Endocrinology and Women's Endocrine Health, Azienda Ospedaliera Universitaria Policlinico 'G. Martino', Messina, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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13
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Chen W, Luo YK, Zhang Y, Song Q, Tang J. Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma. BMC Cancer 2021; 21:834. [PMID: 34284748 PMCID: PMC8290620 DOI: 10.1186/s12885-021-08500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma. METHODS Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1-3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded. RESULTS The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24-50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01). CONCLUSION US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
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Affiliation(s)
- Wei Chen
- Department of Ultrasound, The Seventh Medical Center, Medical College of PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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14
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Clinical Indications for Treatment with Multi-Kinase Inhibitors in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13092279. [PMID: 34068664 PMCID: PMC8126102 DOI: 10.3390/cancers13092279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Differentiated thyroid cancer is usually a slow-growing disease, even if the patients develop distant metastasis. For recurrent or metastatic disease, radioactive iodine therapy is a standard treatment. However, the disease gradually progresses in some of the patients and can ultimately develop into life-threatening conditions. For patients with progressive radioactive iodine-refractory differentiated thyroid cancer (RR-DTC), multi-kinase inhibitors (MKIs) including sorafenib and lenvatinib prolonged progression-free survival compared with placebo in pivotal randomized phase 3 trials, although the benefit in overall survival has not been clearly confirmed, possibly because the patients who received placebo were permitted to cross-over to lenvatinib upon disease progression. Moreover, the adverse events related to MKIs were not negligible. Therefore, the optimal timing of MKI initiation has long been controversial, and physicians should consider various patient and disease factors. Herein, we comprehensively review the clinical factors that can be helpful in determining the initiation of MKIs for patients with RR-DTC.
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15
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Kim SJ, Bomberg EM, Menke J, Russell M, Murphy EJ. Recurrent follicular thyroid carcinoma metastatic to axillary lymph nodes mimicking pulmonary adenocarcinoma. Endocrinol Diabetes Metab Case Rep 2021. [PMCID: PMC7923111 DOI: 10.1530/edm-20-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Differentiated thyroid cancers generally have favorable prognoses, though follicular thyroid cancer is overall associated with a worse prognosis due in part to increased incidence of distant metastasis. We report a case of a 51-year-old woman with a history of widely invasive follicular thyroid carcinoma treated with a total thyroidectomy, radioactive iodine and external beam radiation. Five and a half years following her surgery, she was found to have an axillary lymph node mass, multiple lung masses, and a hilar mass in the setting of declining thyroglobulin (Tg) antibodies. Her metastases were initially thought to be due to a primary lung adenocarcinoma given a neoplastic cell immunophenotype that included an absence of Tg expression and co-expression of TTF-1 and Napsin A. However, PAX8 expression demonstrated that the axillary and hilar metastases were actually thyroid in origin rather than lung. Axillary metastases in differentiated thyroid carcinoma are exceedingly rare and previous reports have typically involved widely disseminated disease with extensive neck lymphadenopathy. With a decline in Tg antibodies levels in high-risk patients, one should consider progression and loss of differentiation of thyroid carcinoma rather than a response to treatment.
Learning points:
Axillary metastases in differentiated thyroid carcinoma are uncommon.
In patients with high-risk thyroid carcinomas, a decline in thyroglobulin antibody may not signal disease improvement, but rather a progression to a poorly differentiated form of cancer.
PAX8 staining can be used to differentiate thyroid carcinomas from lung adenocarcinomas.
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Affiliation(s)
- Stephanie J Kim
- 1Division of Endocrinology & Metabolism, University of California, San Francisco, California, USA
| | - Eric Morris Bomberg
- 2Department of Pediatrics, Division of Endocrinology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joshua Menke
- 3Department of Pathology, University of California, San Francisco, California, USA
| | - Marika Russell
- 4Department of Otolaryngology, University of California, San Francisco, California, USA
| | - Elizabeth J Murphy
- 1Division of Endocrinology & Metabolism, University of California, San Francisco, California, USA
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16
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The Antitumour Effect of Prunella vulgaris Extract on Thyroid Cancer Cells In Vitro and In Vivo. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8869323. [PMID: 33505511 PMCID: PMC7811421 DOI: 10.1155/2021/8869323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
Prunella vulgaris, a traditional Chinese medicine, has been used to treat various benign and malignant tumours for centuries in China. In our previous studies, Prunella vulgaris extract (PVE) was shown to promote apoptosis in differentiated thyroid cancer (DTC) cells. However, whether other mechanisms are involved in the antitumour effect of PVE in thyroid cancer (TC) cells remains unclear. The present study aimed to investigate the antiproliferative and antimigratory effects of PVE on TC cell lines both in vitro and in vivo. First, the TPC-1 and SW579 human TC cell lines were screened by MTT assay for their high level of sensitivity to PVE. Then, the results of cell growth curve and colony formation assay and cell cycle analyses, wound healing, and migration assays demonstrated that PVE inhibited the proliferation and migration of TPC-1 and SW579 cells. Moreover, the antitumour effect of PVE was verified in a subcutaneous xenotransplanted tumour model. Next, MKI67, PCNA, CTNNB1, and CDH1 were screened by qRT-PCR for their significantly differential expression levels in xenograft tissue with and without PVE treatment, and expression of MKI67, PCNA, and CDH1 was verified by Western blot. Finally, an integrated bioinformatics analysis containing protein-protein interaction network, KEGG pathway, and GO analysis was conducted to explore more potential antitumour mechanisms of PVE. In summary, PVE could inhibit the proliferation and migration of TC cells both in vitro and in vivo, which may have been achieved by modulation of the expression of MKI67, PCNA, and CDH1. These data suggest that PVE has the potential to be developed into a new anticancer drug for the treatment of TC.
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17
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Fallahi P, Ferrari SM, Galdiero MR, Varricchi G, Elia G, Ragusa F, Paparo SR, Benvenga S, Antonelli A. Molecular targets of tyrosine kinase inhibitors in thyroid cancer. Semin Cancer Biol 2020; 79:180-196. [PMID: 33249201 DOI: 10.1016/j.semcancer.2020.11.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
Thyroid cancer (TC) is the eighth most frequently diagnosed cancer worldwide with a rising incidence in the past 20 years. Surgery is the primary strategy of therapy for patients with medullary TC (MTC) and differentiated TC (DTC). In DTC patients, radioactive iodine (RAI) is administered after thyroidectomy. Neck ultrasound, basal and thyroid-stimulating hormone-stimulated thyroglobulin are generally performed every three to six months for the first year, with subsequent intervals depending on initial risk assessment, for the detection of possible persistent/recurrent disease during the follow up. Distant metastases are present at the diagnosis in ∼5 % of DTC patients; up to 15 % of patients have recurrences during the follow up, with a survival reduction (70 %-50 %) at 10-year. During tumor progression, the iodide uptake capability of DTC cancer cells can be lost, making them refractory to RAI, with a negative impact on the prognosis. Significant advances have been done recently in our understanding of the molecular pathways implicated in the progression of TCs. Several drugs have been developed, which inhibit signaling kinases or oncogenic kinases (BRAFV600E, RET/PTC), such as those associated with Platelet-Derived Growth Factor Receptor and Vascular Endothelial Growth Factor Receptor. Tyrosine kinase receptors are involved in cancer cell proliferation, angiogenesis, and lymphangiogenesis. Several tyrosine kinase inhibitors (TKIs) are emerging as new treatments for DTC, MTC and anaplastic TC (ATC), and can induce a clinical response and stabilize the disease. Lenvatinib and sorafenib reached the approval for RAI-refractory DTC, whereas cabozantinib and vandetanib for MTC. These TKIs extend median progression-free survival, but do not increase the overall survival. Severe side effects and drug resistance can develop in TC patients treated with TKIs. Additional studies are needed to identify a potential effective targeted therapy for aggressive TCs, according to their molecular characterization.
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Affiliation(s)
- Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Martina Ferrari
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Maria Rosaria Galdiero
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; Center for Basic and Clinical Immunology Research, University of Naples Federico II, 80131 Naples, Italy; World Allergy Organization Center of Excellence, University of Naples Federico II, 80131 Naples, Italy; Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore", National Research Council, 80131 Naples, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; Center for Basic and Clinical Immunology Research, University of Naples Federico II, 80131 Naples, Italy; World Allergy Organization Center of Excellence, University of Naples Federico II, 80131 Naples, Italy; Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore", National Research Council, 80131 Naples, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Sabrina Rosaria Paparo
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Messina, Messina, Italy; Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy; Interdepartmental Program on Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital, A.O.U. Policlinico Gaetano Martino, Messina, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy.
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18
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Chen J, Li XL, Zhang YF, Wang D, Wang Q, Zhao CK, Li MX, Wei Q, Ji G, Xu HX. Ultrasound validation of predictive model for central cervical lymph node metastasis in papillary thyroid cancer on BRAF. Future Oncol 2020; 16:1607-1618. [PMID: 32501726 DOI: 10.2217/fon-2020-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aim: To compare the value of predictive power of the models for central cervical lymph node metastasis (CLNM) in papillary thyroid carcinomas (PTCs). Patients & methods: 220 PTCs were prospectively enrolled into the study with pathological examination. We established a new risk model with univariate and multivariate analyses and receiver-operating characteristic curves were plotted. Z-test was performed to compare the area under two curves and validated the predictive model for central CLNM in PTCs. The comparison of previous and new predictive model was analyzed. Results: Microcalcification, capsule contact or involvement, internal flow and BRAFV600E mutation were four independent risk factors for PTCs with central CLNMs. The area under the curves for the new and the previous model were 0.948 and 0.934 (p = 0.572), respectively. Conclusion: Two predictive models showed strong consistency in predicting central CLNM in PTCs. The predictive model may be helpful in selecting appropriate treatment method in PTCs.
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Affiliation(s)
- Jie Chen
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China.,Department of Medical Ultrasound, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, PR China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Ming-Xu Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China
| | - Guo Ji
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research & Education Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, PR China.,Shanghai Center for Thyroid Disease, Shanghai 200072, PR China
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19
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Pešorda M, Kusačić Kuna S, Huić D, Herceg D, Despot M, Samardžić T, Gnjidić M, Belev B. Kinase Inhibitors in the Treatment of Thyroid Cancer: Institutional Experience. Acta Clin Croat 2020; 59:73-80. [PMID: 34219887 PMCID: PMC8212607 DOI: 10.20471/acc.2020.59.s1.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although most patients with thyroid cancer have a favorable clinical course, some patients develop a more aggressive type of cancer and exhibit more rapid disease progression with worse prognosis. Those patients usually exhibit mutations of proteins such as tyrosine kinase enzymes that play a significant role in regulation of tumor proliferation and spreading. Development of targeted therapies is based on the inhibition of mutated kinases which are involved in the MAPK signaling pathway. The aim of this study was to present the initial results of clinical experience with kinase inhibitors in patients with metastatic differentiated thyroid cancer (DTC), poorly differentiated thyroid cancer (PDTC), and medullary thyroid cancer (MTC) who exhibited rapid disease progression. A total of 17 adult patients (11 women, mean age 53.3 years) managed for progressive, metastatic disease were included in the study. Twelve patients with DTC and PDTC were previously tested for BRAF mutations, of whom nine that had tumor tissue negative for the BRAF V600E mutation received sorafenib, while three patients with tumors harboring the BRAF V600E mutation were treated with vemurafenib. Patients with MTC were treated with sunitinib, vandetanib, and sorafenib. Two patients with tumors harboring the BRAF mutation treated with vemurafenib showed restoration of radioiodine uptake. Most of patients showed significant improvement in disease status but of limited duration until disease progression. Although there was an improvement in progression-free survival, future research has to achieve a greater and longer-lasting response, probably by utilizing combined targeted therapy.
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Affiliation(s)
| | - Sanja Kusačić Kuna
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Dražen Huić
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Davorin Herceg
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Marija Despot
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Tatjana Samardžić
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Milena Gnjidić
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Borislav Belev
- 1Clinical Department of Nuclear Medicine and Radiation Protection, Zagreb University Hospital Centre, Zagreb, Croatia; 2Clinical Department of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3The University of Zagreb School of Medicine, Zagreb, Croatia; 4The University of Zagreb School of Dental Medicine, Zagreb, Croatia
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20
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Li J, Zhang L, Li W, Lei C, Cao Y, Wang Y, Wang Z, Pang H. Preparation and SPECT/CT Imaging of 177Lu-Labeled Peptide Nucleic Acid (PNA) Targeting CITED1: Therapeutic Evaluation in Tumor-Bearing Nude Mice. Onco Targets Ther 2020; 13:487-496. [PMID: 32021292 PMCID: PMC6970276 DOI: 10.2147/ott.s238098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/03/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose The expression of Cbp/p300-interacting transactivator with Glu/Asp-rich carboxy-terminal domain 1 (CITED1) is upregulated in papillary thyroid carcinoma (PTC) and mediates cell proliferation and migration. To facilitate early diagnosis and monitoring of recurrent or metastatic PTC, we designed 177Lu-labeled antisense peptide nucleic acid (PNA) targeting CITED1 mRNA to evaluate the therapeutic potential, while analyzing its distribution in nude mice and the characteristics withsingle-photon emission-computed tomography/computed tomography (SPECT/CT) imaging. Materials and Methods 177Lu-DOTA-anti-CITED1-PNA (177Lu-asPNA) was obtained by indirect labeling. High-performance liquid chromatography (HPLC) and thin-layer chromatography (TLC) were used to determine the labeling rate and radiochemical purity. The stability of 177Lu-asPNA was evaluated by TLC, and the radioactivity count was measured by a γ counter to calculate its uptake capacity in K1 cells. To analyze the distribution of 177Lu-asPNA in body tissues and organs of nude mice, static single-photon emission-computed tomography (SPECT) imaging and SPECT/CT image fusion were performed. Then, the therapeutic effects of probes were explored by tumor growth curves and survival analysis. Results Our probe showed a radiochemical purity of 96.5±0.15% at 1 hr and specific activity of 8.7±0.53 MBq/μg. The uptake rate in the 177Lu-asPNA group was much higher than that in the 177Lu-DOTA-nonsense-PNA (177Lu-nonsense-PNA) and 177Lu-DOTA groups (P<0.05). The biological distribution showed that the tumor/muscle ratio was at its highest at 24 h (4.98±0.34) post-inoculation, with SPECT/CT imaging showing clear tumor development. By measuring tumor volume of tumor-bearing nude mice, the 177Lu-asPNA group showed a significant difference in tumor size 9 days after injection (P < 0.05). Kaplan-Meier survival curves showed that the overall survival rate in the 177Lu-asPNA group was significantly different from those in the DOTA-anti-CITED1-PNA (asPNA) and saline groups (P = 0.002, log-rank test). Conclusion 177Lu-asPNA was developed successfully, showing a high labeling rate and good stability. SPECT/CT imaging demonstrated tumor growth in nude mice, which was effectively inhibited by our probe, thus prolonging survival.
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Affiliation(s)
- Jia Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Lei Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wenbo Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengming Lei
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yiyi Cao
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ying Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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21
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Fleeman N, Houten R, Bagust A, Richardson M, Beale S, Boland A, Dundar Y, Greenhalgh J, Hounsome J, Duarte R, Shenoy A. Lenvatinib and sorafenib for differentiated thyroid cancer after radioactive iodine: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-180. [PMID: 31931920 PMCID: PMC6983913 DOI: 10.3310/hta24020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Thyroid cancer is a rare cancer, accounting for only 1% of all malignancies in England and Wales. Differentiated thyroid cancer (DTC) accounts for ≈94% of all thyroid cancers. Patients with DTC often require treatment with radioactive iodine. Treatment for DTC that is refractory to radioactive iodine [radioactive iodine-refractory DTC (RR-DTC)] is often limited to best supportive care (BSC). OBJECTIVES We aimed to assess the clinical effectiveness and cost-effectiveness of lenvatinib (Lenvima®; Eisai Ltd, Hertfordshire, UK) and sorafenib (Nexar®; Bayer HealthCare, Leverkusen, Germany) for the treatment of patients with RR-DTC. DATA SOURCES EMBASE, MEDLINE, PubMed, The Cochrane Library and EconLit were searched (date range 1999 to 10 January 2017; searched on 10 January 2017). The bibliographies of retrieved citations were also examined. REVIEW METHODS We searched for randomised controlled trials (RCTs), systematic reviews, prospective observational studies and economic evaluations of lenvatinib or sorafenib. In the absence of relevant economic evaluations, we constructed a de novo economic model to compare the cost-effectiveness of lenvatinib and sorafenib with that of BSC. RESULTS Two RCTs were identified: SELECT (Study of [E7080] LEnvatinib in 131I-refractory differentiated Cancer of the Thyroid) and DECISION (StuDy of sorafEnib in loCally advanced or metastatIc patientS with radioactive Iodine-refractory thyrOid caNcer). Lenvatinib and sorafenib were both reported to improve median progression-free survival (PFS) compared with placebo: 18.3 months (lenvatinib) vs. 3.6 months (placebo) and 10.8 months (sorafenib) vs. 5.8 months (placebo). Patient crossover was high (≥ 75%) in both trials, confounding estimates of overall survival (OS). Using OS data adjusted for crossover, trial authors reported a statistically significant improvement in OS for patients treated with lenvatinib compared with those given placebo (SELECT) but not for patients treated with sorafenib compared with those given placebo (DECISION). Both lenvatinib and sorafenib increased the incidence of adverse events (AEs), and dose reductions were required (for > 60% of patients). The results from nine prospective observational studies and 13 systematic reviews of lenvatinib or sorafenib were broadly comparable to those from the RCTs. Health-related quality-of-life (HRQoL) data were collected only in DECISION. We considered the feasibility of comparing lenvatinib with sorafenib via an indirect comparison but concluded that this would not be appropriate because of differences in trial and participant characteristics, risk profiles of the participants in the placebo arms and because the proportional hazard assumption was violated for five of the six survival outcomes available from the trials. In the base-case economic analysis, using list prices only, the cost-effectiveness comparison of lenvatinib versus BSC yields an incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained of £65,872, and the comparison of sorafenib versus BSC yields an ICER of £85,644 per QALY gained. The deterministic sensitivity analyses show that none of the variations lowered the base-case ICERs to < £50,000 per QALY gained. LIMITATIONS We consider that it is not possible to compare the clinical effectiveness or cost-effectiveness of lenvatinib and sorafenib. CONCLUSIONS Compared with placebo/BSC, treatment with lenvatinib or sorafenib results in an improvement in PFS, objective tumour response rate and possibly OS, but dose modifications were required to treat AEs. Both treatments exhibit estimated ICERs of > £50,000 per QALY gained. Further research should include examination of the effects of lenvatinib, sorafenib and BSC (including HRQoL) for both symptomatic and asymptomatic patients, and the positioning of treatments in the treatment pathway. STUDY REGISTRATION This study is registered as PROSPERO CRD42017055516. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nigel Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rachel Houten
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Adrian Bagust
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Juliet Hounsome
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Aditya Shenoy
- The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
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22
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Fleeman N, Houten R, Chaplin M, Beale S, Boland A, Dundar Y, Greenhalgh J, Duarte R, Shenoy A. A systematic review of lenvatinib and sorafenib for treating progressive, locally advanced or metastatic, differentiated thyroid cancer after treatment with radioactive iodine. BMC Cancer 2019; 19:1209. [PMID: 31830943 PMCID: PMC6909631 DOI: 10.1186/s12885-019-6369-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/18/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Treatment with radioactive iodine is effective for many patients with progressive, locally advanced or metastatic, differentiated thyroid cancer. However, some patients become refractory to treatment. These types of patients are considered to have radioactive iodine refractory differentiated thyroid cancer (RR-DTC). METHODS We searched Embase, MEDLINE, PubMed and the Cochrane Library from January 1999 through January 2017. Reference lists of included studies and ongoing trial registries were also searched. Reports of randomized controlled trials (RCTs), prospective observational studies, and systematic reviews/indirect comparisons were eligible for inclusion. In the absence of direct clinical trial evidence comparing lenvatinib versus sorafenib, we assessed the feasibility of conducting an indirect comparison to obtain estimates of the relative efficacy and safety of these two treatments. RESULTS Of 2364 citations, in total, 93 papers reporting on 2 RCTs (primary evidence), 9 observational studies and 13 evidence reviews (supporting evidence) were identified. Compared to placebo, RCT evidence demonstrated improvements with lenvatinib or sorafenib in median progression-free survival (PFS) and objective tumour response rate (ORR). Overall survival (OS) was confounded by high treatment crossover (≥75%) in both trials. Adverse events (AEs) were more common with lenvatinib or sorafenib than with placebo but the most common AEs associated with each drug differed. Primarily due to differences in the survival risk profiles of patients in the placebo arms of the RCTs, we considered it inappropriate to indirectly compare the effectiveness of lenvatinib versus sorafenib. ORR and AE findings for lenvatinib and sorafenib from the supporting evidence were broadly in line with RCT evidence. Health-related quality of life (HRQoL) data were limited. CONCLUSIONS Lenvatinib and sorafenib are more efficacious than placebo (a proxy for best supportive care) for treating RR-DTC. Uncertainty surrounds the extent of the impact on OS and HRQoL. Lenvatinib could not reliably be compared with sorafenib. Choice of treatment is therefore likely to depend on an individual patient's circumstances.
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Affiliation(s)
- Nigel Fleeman
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Rachel Houten
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Marty Chaplin
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Sophie Beale
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Angela Boland
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Yenal Dundar
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Janette Greenhalgh
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Rui Duarte
- Liverpool Reviews & Implementation Group (LRiG), Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Whelan Building, Liverpool, L69 3GB UK
| | - Aditya Shenoy
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral UK
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23
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Lee EK, Kim SM, Kim BH, Kim MJ, Lim DJ, Kim MH, Shin DY, Kang HC, Ahn BC, Kim SW, Ahn HY, Park YJ. Lesion-Based Evaluation Predicts Treatment Response to Lenvatinib for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Korean Multicenter Retrospective Study. Thyroid 2019; 29:1811-1819. [PMID: 31482759 DOI: 10.1089/thy.2019.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Lenvatinib, a tyrosine kinase inhibitor (TKI) recently approved for treating radioactive iodine-refractory differentiated thyroid cancer, has been shown to delay disease progression and provide meaningful benefit for overall survival (OS). However, there is no predictive marker for response to lenvatinib before initiating treatment. We comprehensively analyzed clinical and radiological parameters to predict response to lenvatinib using lesion-based assessments. Methods: Medical records were collected from 67 patients treated with lenvatinib in 11 referral hospitals across Korea from June 2015 to December 2017. Up to 96 measurable lesions, defined as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, were evaluated serially until progressive disease (PD) occurred, and tumor doubling time (TDT) was calculated based on changes between historical computed tomography (CT) scans and baseline CT scans performed at treatment initiation. Results: Excluding patients with anaplastic thyroid cancer, no thyroidectomy, nontarget lesions only, or treatment periods of <1 month, 57 patients were analyzed, of whom 7 (12.2%) were TKI-naive. The median progression-free survival was 5.1 months (95% confidence interval [CI], 4.4-9.5), the median OS was 19.3 months (95% CI 12.4-not reached), the mean duration of response was 6.0 ± 4.4 months, and the objective response rate was 38%. In lesion-based assessments, 31 lesions (32.2%) with significant tumor shrinkage (complete remission or partial response) were significantly associated with shorter TDT (<12 months; p = 0.02). Patients with rapidly PD with a shorter initial TDT (<6 months) were more likely to respond to lenvatinib (p = 0.03). Patients exposed to lenvatinib at an average of ≥16 mg per day, or who were TKI-naive before treatment with lenvatinib, had a lower risk of progression; however, the risk reduction did not reach statistical significance (daily dosage p = 0.07, TKI exposure p = 0.09). Conclusions: TDT calculations at the beginning of treatment and lesion-based tumor assessment may help identify potential responders to lenvatinib therapy and predict therapeutic responses.
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Affiliation(s)
- Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Dong-Jun Lim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min-Hee Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong Yeob Shin
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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24
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Latorre A, Fioretti AM, Giotta F, Lorusso V. Efficacy and safety of lenvatinib in an elderly patient with metastatic papillary thyroid carcinoma and cardiological comorbidity: a case report. Future Oncol 2019; 15:27-33. [PMID: 31393171 DOI: 10.2217/fon-2019-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lenvatinib significantly prolonged progression-free survival versus placebo in patients with radio-iodine refractory differentiated thyroid carcinoma. However, the primary adverse effects of any grade that occurred in >40% of patients in the lenvatinib group of the Phase III SELECT trial was hypertension (67.8%). Therefore, this drug should be used with caution in patients with cardiological morbidity. Here, we describe the case of a 73-year-old man with hypertension, obesity and chronic atrial fibrillation, who received lenvatinib for 6 months in the absence of cardiological symptoms.
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Affiliation(s)
- Agnese Latorre
- UO Oncologia Medica, Istituto Tumori "G Paolo II" Bari, Bari, Italy
| | | | - Francesco Giotta
- UO Oncologia Medica, Istituto Tumori "G Paolo II" Bari, Bari, Italy
| | - Vito Lorusso
- UO Oncologia Medica, Istituto Tumori "G Paolo II" Bari, Bari, Italy
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25
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Rodia R, Marini S, Pani F, Boi F, Mariotti S. Embolization of iliac metastasis during lenvatinib treatment in patient with advanced Hürthle cell thyroid carcinoma. Future Oncol 2019; 15:35-40. [PMID: 31385535 DOI: 10.2217/fon-2019-0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Lenvatinib is a tyrosine kinase inhibitor (TKI) with antiproliferative and antiangiogenic effects indicated for the treatment of progressive, locally advanced or metastatic progressive thyroid carcinoma, refractory to radioactive iodine therapy. Antiangiogenic therapies induce ischemic necrosis of tumor tissue, with increased risk of hemorrhagic complications. The management of hemorrhagic risk is based on precautionary measures and for any surgical procedure, it is advised to interrupt the treatment in order to avoid complications. 'Flare-up' of tumor activity may follow TKI interruption. However, it is not known if continuing TKIs during minimally invasive interventions is safe. We report here the first case in which an embolization of metastasis is performed without interrupting lenvatinib treatment. The procedure was successful and free of complications.
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Affiliation(s)
- Rossella Rodia
- Department of Medical Sciences & Public Health, Postgraduate School of Endocrinology & Metabolic Diseases, University of Cagliari, Cagliari, Italy.,Endocrinology Unit "Duilio Casula" Hospital, AOU Monserrato, Cagliari, Italy
| | - Stefano Marini
- Department of Radiology, SS Trinità Hospital, ASSL Cagliari, Cagliari, Italy
| | - Fabiana Pani
- Department of Medical Sciences & Public Health, Postgraduate School of Endocrinology & Metabolic Diseases, University of Cagliari, Cagliari, Italy.,Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Ross Research Building-Room 656, 720 Rutland Avenue, Baltimore, MD 21205, USA
| | - Francesco Boi
- Department of Medical Sciences & Public Health, Postgraduate School of Endocrinology & Metabolic Diseases, University of Cagliari, Cagliari, Italy.,Endocrinology Unit "Duilio Casula" Hospital, AOU Monserrato, Cagliari, Italy
| | - Stefano Mariotti
- Department of Medical Sciences & Public Health, Postgraduate School of Endocrinology & Metabolic Diseases, University of Cagliari, Cagliari, Italy.,Endocrinology Unit "Duilio Casula" Hospital, AOU Monserrato, Cagliari, Italy
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26
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Yu ST, Ge JN, Luo JY, Wei ZG, Sun BH, Lei ST. Treatment-related adverse effects with TKIs in patients with advanced or radioiodine refractory differentiated thyroid carcinoma: a systematic review and meta-analysis. Cancer Manag Res 2019; 11:1525-1532. [PMID: 30863162 PMCID: PMC6388981 DOI: 10.2147/cmar.s191499] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Tyrosine kinase inhibitors (TKIs) have been administered to advanced or radio-iodine refractory differentiated thyroid carcinoma (RR-DTC) patients for years. We performed a pooled analysis to explore the frequency of severe adverse effects in advanced or RR-DTC patients treated with sorafenib and lenvatinib. Methods We performed a comprehensive search of computerized databases, including PubMed, Web of Science, Ovid, EMASE, and the Cochrane Library, from the drugs' inception to July 2018 to identify clinical trials. All grade and severe adverse events (AEs; grade ≥3) were analyzed. This meta-analysis was conducted in accordance with PRISMA guidelines. Results In total, seve studies published from 2012-2018 with 657 patients were eligible for this study. We included two studies (238 patients) that received 200 mg sorafenib twice and five studies (419 patients) that received 24 mg lenvatinib daily. The frequency of AEs was different among the two drugs. Patients in the sorafenib group had a significantly higher frequency of all grade hand-foot syndrome, hypocalcemia, rash, elevated alanine aminotransferase (ALT), and elevated aspartate aminotransferase (AST). Conversely, the lenvatinib group experienced more frequent all grade voice change, hypertension, nausea, and vomiting compared with those with sorafenib. For grade ≥3 adverse effects, hand-foot syndrome, hypocalcemia, and elevated ALT were more frequent in sorafenib-treated patients. Moreover, lenvatinib-treated patients had a significantly higher incidence of severe weight loss, hypertension, and nausea. Conclusion Significant differences in common adverse effects, such as all-grade and severe AEs, were detected between sorafenib and lenvatinib in the current study. Early intervention and management of treatment-related AEs (TRAEs) can minimize the impact on patients' quality-of-life, and avoid unnecessary dose reductions and treatment-related discontinuations.
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Affiliation(s)
- Shi-Tong Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
| | - Jun-Na Ge
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
| | - Jing-Yi Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhi-Gang Wei
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
| | - Bai-Hui Sun
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
| | - Shang-Tong Lei
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
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27
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Vella V, Nicolosi ML, Cantafio P, Massimino M, Lappano R, Vigneri P, Ciuni R, Gangemi P, Morrione A, Malaguarnera R, Belfiore A. DDR1 regulates thyroid cancer cell differentiation via IGF-2/IR-A autocrine signaling loop. Endocr Relat Cancer 2019; 26:197-214. [PMID: 30121624 DOI: 10.1530/erc-18-0310] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/31/2022]
Abstract
Patients with thyroid cancers refractory to radioiodine (RAI) treatment show a limited response to various therapeutic options and a low survival rate. The recent use of multikinase inhibitors has also met limited success. An alternative approach relies on drugs that induce cell differentiation, as the ensuing increased expression of the cotransporter for sodium and iodine (NIS) may partially restore sensitivity to radioiodine. The inhibition of the ERK1/2 pathway has shown some efficacy in this context. Aggressive thyroid tumors overexpress the isoform-A of the insulin receptor (IR-A) and its ligand IGF-2; this IGF-2/IR-A loop is associated with de-differentiation and stem-like phenotype, resembling RAI-refractory tumors. Importantly, IR-A has been shown to be positively modulated by the non-integrin collagen receptor DDR1 in human breast cancer. Using undifferentiated human thyroid cancer cells, we now evaluated the effects of DDR1 on IGF-2/IR-A loop and on markers of cell differentiation and stemness. DDR1 silencing or downregulation caused significant reduction of IR-A and IGF-2 expression, and concomitant increased levels of differentiation markers (NIS, Tg, TSH, TPO). Conversely, markers of epithelial-to-mesenchymal transition (Vimentin, Snail-2, Zeb1, Zeb2 and N-Cadherin) and stemness (OCT-4, SOX-2, ABCG2 and Nanog) decreased. These effects were collagen independent. In contrast, overexpression of either DDR1 or its kinase-inactive variant K618A DDR1-induced changes suggestive of less differentiated and stem-like phenotype. Collagen stimulation was uneffective. In conclusion, in poorly differentiated thyroid cancer, DDR1 silencing or downregulation blocks the IGF-2/IR-A autocrine loop and induces cellular differentiation. These results may open novel therapeutic approaches for thyroid cancer.
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Affiliation(s)
- Veronica Vella
- School of Human and Social Sciences, 'Kore' University of Enna, Enna, Italy
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Maria Luisa Nicolosi
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - Patrizia Cantafio
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Michele Massimino
- Center of Experimental Oncology and Hematology, AOU Policlinico Vittorio Emanuele, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosamaria Lappano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Paolo Vigneri
- Center of Experimental Oncology and Hematology, AOU Policlinico Vittorio Emanuele, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberto Ciuni
- Unit of Thyroid and Neck Surgery, Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Pietro Gangemi
- Unit of Pathology, Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Andrea Morrione
- Department of Urology and Biology of Prostate Cancer Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Roberta Malaguarnera
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
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28
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Jayarangaiah A, Sidhu G, Brown J, Barrett-Campbell O, Bahtiyar G, Youssef I, Arora S, Skwiersky S, McFarlane SI. Therapeutic options for advanced thyroid cancer. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2019; 5:26-34. [PMID: 31709422 PMCID: PMC6839707 DOI: 10.17352/ijcem.000040] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thyroid cancer can be largely classified as well-differentiated, poorly differentiated, medullary and anaplastic. Differentiated thyroid cancer (DTC) includes follicular and papillary subtypes, with the incidence of papillary thyroid cancer (PTC) on the rise. The mainstay of treatment for DTC includes a combination of surgery, radioactive iodine (RAI) and levothyroxine suppression. DTC portends a favorable prognosis, even in the presence of distant metastases, with a 50% rate of 5-year survival largely due to tumor cell's sensitivity to RAI therapy influencing disease outcome. In radioactive iodine refractory differentiated thyroid cancer (RAI-refractory DTC) there is a lower survival rate prompting the use of other therapeutic options available. RAI refractoriness is more common in older patients (age >40), large metastases and lesions that are fluorodeoxyglucose (FDG) avid on position emission tomography (PET). Over the past decade, Identification of genetic mutations in the signaling pathway involved in thyroid tumorigenesis has led to the approval of tyrosine kinase inhibitors (TKIs); Sorafenib and Lenvatinib in RAI-refractory DTC. Similarly, metastatic medullary thyroid cancer (MTC) implies an unfavorable 10-year survival rate of only 20% as the principal treatment options focuses on loco regional control via surgical and/or non-surgical options. The approval of TKIs such as Cabozantinib and Vandetanib has introduced an encouraging, novel, systemic therapeutic option for metastatic MTC. Lastly, anaplastic thyroid cancer (ATC) carries the worst prognosis with high recurrence rates. Treatment includes surgery, chemotherapy and external beam radiation. The FDA recently approved Dabrafenib plus trametinib for BRAF V600E mutated ATC. Considering the modality of chemotherapy and the expanding field of targeted therapies, the role of the oncologist and interaction with endocrinologist in the management of thyroid cancer needs further clarification aiming at collaborative management plans more than ever. This review summarizes the key phase III trials that led to the approval of TKIs in the treatment of DTC and metastatic MTC. Additionally, the review aims to clarify the patient selection criteria for initiation of TKIs and examine the implications, considerations and adverse effects prior to utilizing targeted therapy. Clinical trials are ongoing with promising results and may contribute to the addition of several targeted molecules and immune check point inhibitors to the therapeutic armamentarium for RAI-refractory DTC, medullary and anaplastic thyroid cancer.
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Affiliation(s)
- Apoorva Jayarangaiah
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein School of Medicine, New York, USA
| | - Gurinder Sidhu
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Jordonna Brown
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Odeth Barrett-Campbell
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Gul Bahtiyar
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Irini Youssef
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Shalini Arora
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Samara Skwiersky
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Samy I McFarlane
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA,Corresponding author: Samy I McFarlane, MD, MPH, MBA, FACP, Distinguished Teaching Professor and Associate Dean, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York-Downstate Medical Center, 450 Clarkson Avenue, Box 50, Brooklyn, New York, 11203, USA, Tel: 718-270-3711; Fax: 718-270-6358;
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Cabanillas ME, Takahashi S. Managing the adverse events associated with lenvatinib therapy in radioiodine-refractory differentiated thyroid cancer. Semin Oncol 2018; 46:57-64. [PMID: 30685073 DOI: 10.1053/j.seminoncol.2018.11.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
Lenvatinib is a multikinase inhibitor of vascular endothelial growth factor (VEGF) receptors 1-3, fibroblast growth factor receptors 1-4, RET, KIT, and platelet-derived growth factor receptor-α. Lenvatinib is approved as a monotherapy for the treatment of radioiodine-refractory differentiated thyroid cancer and in combination with everolimus for the second-line treatment of advanced renal cell carcinoma. Lenvatinib is also under investigation for the treatment of several malignancies including unresectable hepatocellular carcinoma. Although lenvatinib is associated with favorable efficacy, it is associated with adverse events (AEs) that the clinician will have to closely monitor for and proactively manage. Most of these AEs are known class effects of VEGF-targeted therapies, including hypertension, diarrhea, fatigue or asthenia, decreased appetite, and weight loss. This review summarizes the safety profile of lenvatinib and offers guidance for the management of both frequent and rare AEs. We discuss the potential mechanisms underlying these AEs and present practical recommendations for managing toxicities. The development of treatment plans that include prophylactic and therapeutic strategies for the management of lenvatinib-associated AEs has the potential to improve patient quality of life, optimize adherence, minimize the need for dose reductions, treatment interruptions, or discontinuations, and maximize patient outcomes.
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Affiliation(s)
- Maria E Cabanillas
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Tori M, Shimo T. Long-term efficacy of lenvatinib for recurrent papillary thyroid carcinoma after multimodal treatment and management of complications: a case report. BMC Cancer 2018; 18:698. [PMID: 29954369 PMCID: PMC6022486 DOI: 10.1186/s12885-018-4612-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background The advent of tyrosine kinase inhibitors (TKIs) has changed the treatment of RAI refractory, unresectable recurrent differentiated thyroid cancer (DTC), which was formerly treated with multidisciplinary remedies. Case presentation Here we describe the case of a 64-year-old woman who underwent total thyroidectomy with tracheal resection and suffered from a recurrent tumor in the neck and multiple lung and bone metastases 3 and 11 months, respectively, after the operation. Multimodal therapies, RI (I-131), EBRT, and taxane-based chemotherapy were ineffective, and sorafenib was started as a TKI. However, because of disease progression, sorafenib was replaced by lenvatinib after 9 months. The effect of lenvatinib has continued for more than 1 year and 9 months, and the patient has well survived. During the treatment period, a tracheal pin-hole fistula suddenly emerged, which was naturally cured by the temporary cessation of lenvatinib. Adverse events such as hypertension, proteinuria, and diabetes as innate complications have been successfully managed until the present according to our institute regulations. Conclusions Even where multimodal treatment was ineffective, lenvatinib was suggested to be an alternative treatment option for RAI refractory recurrent DTC and patient could have a chance to be controlled successfully.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan.
| | - Toshirou Shimo
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan
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Cheng X, Yao X, Xu S, Pan J, Yu H, Bao J, Guan H, Lu R, Zhang L. Punicalagin induces senescent growth arrest in human papillary thyroid carcinoma BCPAP cells via NF-κB signaling pathway. Biomed Pharmacother 2018; 103:490-498. [PMID: 29677534 DOI: 10.1016/j.biopha.2018.04.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common endocrine carcinoma. Our previous study revealed that punicalagin (PUN), an active component from pomegranate, triggered autophagic cell death and DNA damage response (DDR) in papillary thyroid carcinoma BCPAP cells. But the detailed anti-cancer mechanisms of punicalagin against PTC still remained to be further explored. DDR activation is a proven cause of cellular senescence, which mediates anti-tumor processes under certain circumstances. In this study, we reported that punicalagin treatment generated a senescent phenotype of BCPAP cells characterized as altered morphology, increased cell granularity and senescence-associated β-galactosidase (SA-β-Gal) staining. Senescence induced by punicalagin treatment was further confirmed by cell cycle arrest and upregulation of cyclin-dependent kinase inhibitor p21. Meanwhile, the senescence-associated secretory phenotype (SASP) included high levels of inflammatory cytokines, principally IL-6 and IL-1β. Furthermore, punicalagin exposure caused the phosphorylation and subsequent degradation of IκBα as well as the nuclear translocation of p65, suggesting the activation of NF-κB signaling pathway. Inhibition of NF-κB by pyrrolidine dithiocarbamate (PDTC), a selective inhibitor of NF-κB, partially reversed the cellular senescent phenotype induced by punicalagin in BCPAP cells as evidenced by the decreased fraction of SA-β-Gal staining positive cells and blockage of SASP generation. These results collectively showed that punicalagin treatment induced senescent growth arrest and SASP via triggering NF-κB activation. These observations elucidated novel anti-cancer mechanisms of punicalagin and might provide new potential prospects for PTC therapy.
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Affiliation(s)
- Xian Cheng
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China
| | - Xin Yao
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Shichen Xu
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Jie Pan
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Huixin Yu
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China
| | - Jiandong Bao
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China; Department of Endocrinology, JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine. Wuxi, Jiangsu, China
| | - Haixia Guan
- Department of Endocrinology & Metabolism and Institute of Endocrinology, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Rongrong Lu
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Li Zhang
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China.
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Werner TA, Nolten I, Dizdar L, Riemer JC, Schütte SC, Verde PE, Raba K, Schott M, Knoefel WT, Krieg A. IAPs cause resistance to TRAIL-dependent apoptosis in follicular thyroid cancer. Endocr Relat Cancer 2018; 25:295-308. [PMID: 29317481 DOI: 10.1530/erc-17-0479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
Follicular thyroid cancer's (FTC) excellent long-term prognosis is mainly dependent on postoperative radioactive iodine (RAI) treatment. However, once the tumour becomes refractory, the 10-year disease-specific survival rate drops below 10%. The aim of our study was to evaluate the prognostic and biological role of the TRAIL system in FTC and to elucidate the influence of small-molecule-mediated antagonisation of inhibitor of apoptosis proteins (IAPs) on TRAIL sensitivity in vitro Tissue microarrays were constructed from forty-four patients with histologically confirmed FTC. Expression levels of TRAIL and its receptors were correlated with clinicopathological data and overall as well as recurrence-free survival. Non-iodine-retaining FTC cell lines TT2609-bib2 and FTC133 were treated with recombinant human TRAIL alone and in combination with Smac mimetics GDC-0152 or Birinapant. TRAIL-R2/DR5 as well as TRAIL-R3/DcR1 and TRAIL-R4/DcR2 were significantly higher expressed in advanced tumour stages. Both decoy receptors were negatively associated with recurrence-free and overall survival. TRAIL-R4/DcR2 additionally proved to be an independent negative prognostic marker in FTC (HR = 1.446, 95% CI: 1.144-1.826; P < 0.001). In vitro, the co-incubation of Birinapant or GDC-0152 with rh-TRAIL-sensitised FTC cell lines for TRAIL-induced apoptosis, through degradation of cIAP1/2. The TRAIL system plays an important role in FTC tumour biology. Its decoy receptors are associated with poor prognosis as well as earlier recurrence. The specific degradation of cIAP1/2 sensitises FTC cells to TRAIL-induced apoptosis and might highlight a new point of attack in patients with RAI refractory disease.
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Affiliation(s)
- Thomas A Werner
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Inga Nolten
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Levent Dizdar
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jasmin C Riemer
- Institute of PathologyHeinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Sina C Schütte
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Pablo E Verde
- Coordination Centre for Clinical TrialsHeinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Katharina Raba
- Institute for Transplantation Diagnostics and Cell TherapeuticsHeinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matthias Schott
- Division of EndocrinologyHeinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Wolfram T Knoefel
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A)Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
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33
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Werner TA, Forster CM, Dizdar L, Verde PE, Raba K, Schott M, Knoefel WT, Krieg A. CXCR4/CXCR7/CXCL12-Axis in Follicular Thyroid Carcinoma. J Cancer 2018; 9:929-940. [PMID: 29581772 PMCID: PMC5868160 DOI: 10.7150/jca.23042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/13/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Follicular thyroid carcinoma's (FTC) often benign course is partially due to adjuvant radioactive iodine (RAI) treatment. However, once the tumour has spread and fails to retain RAI, the therapeutic options are limited and the outcome is poor. In this subset of patients, the identification of novel druggable biomarkers appears invaluable. Here, we investigated the stage dependent expression and functional role of the C-X-C chemokine receptors type 4 and 7 (CXCR4/7) in FTC. Methods: CXCR4/7 expression was examined in 44 FTC and corresponding non-neoplastic thyroid specimens as well as 10 FTC distant metastases and 18 follicular adenomas using tissue microarray technology. Expression levels were correlated with clinicopathological variables as well as overall and recurrence free survival. Changes regarding cell cycle activation, tumour cell invasiveness and mRNA expression of genes related to epithelial-mesenchymal transition (EMT) were investigated after treatment with recombinant human SDF1α/CXCL12 (rh-SDF1α) and CXCR4 antagonists AMD3100 and WZ811. Results: CXCR4/7 expression was associated with large tumour size, advanced UICC stage as well as shorter overall and recurrence free survival. CXCR4 was significantly higher expressed in distant metastases than in primary tumour cores. In addition, rh-SDF1α induced invasive growth, cell cycle activation and EMT, while CXCR4 antagonists significantly reduced FTC invasiveness in vitro. Conclusion: Here we provide first evidence of the biological importance of the CXCR4/CXCR7/CXCL12 axis in FTC. Our findings underscore the therapeutic potential of this chemokine receptor family in advanced FTC and offer new valuable insight into the oncogenesis of metastatic FTC.
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Affiliation(s)
- Thomas Artur Werner
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Christina Maria Forster
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Levent Dizdar
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Pablo Emilio Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Katharina Raba
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Matthias Schott
- Division of Endocrinology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
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Zhang L, Yang Z, Granieri L, Pasculescu A, Datti A, Asa SL, Xu Z, Ezzat S. High-throughput drug library screening identifies colchicine as a thyroid cancer inhibitor. Oncotarget 2018; 7:19948-59. [PMID: 26942566 PMCID: PMC4991430 DOI: 10.18632/oncotarget.7890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/09/2016] [Indexed: 12/12/2022] Open
Abstract
We employed a high-throughput drug library screening platform to identify novel agents affecting thyroid cancer cells. We used human thyroid cancer cell lines to screen a collection of approximately 5200 small molecules with biological and/or pharmacologial properties. Parallel primary screens yielded a number of hits differentially active between thyroid and melanoma cells. Amongst compounds specifically targeting thyroid cancer cells, colchicine emerged as an effective candidate. Colchicine inhibited cell growth which correlated with G2 cell cycle arrest and apoptosis. These effects were hampered through inhibition of MEK1/2 and JNK. In contrast, inhibition of p38-MAPK had little effect, and AKT had no impact on colchicine action. Systemic colchicine inhibited thyroid cancer progression in xenografted mice. These findings demonstrate that our screening platform is an effective vehicle for drug reposition and show that colchicine warrants further attention in well-defined clinical niches such as thyroid cancer.
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Affiliation(s)
- Le Zhang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, P.R. China.,Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Zhaoying Yang
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, P.R. China.,Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Letizia Granieri
- SMART Laboratory for High-Throughput Screening Programs, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Toronto, ON, Canada
| | - Adrian Pasculescu
- SMART Laboratory for High-Throughput Screening Programs, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Toronto, ON, Canada
| | - Alessandro Datti
- SMART Laboratory for High-Throughput Screening Programs, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Toronto, ON, Canada.,Department of Agricultural, Food, and Environmental Sciences, University of Perugia, Perugia, Italy
| | - Sylvia L Asa
- Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Toronto, ON, Canada
| | - Zheli Xu
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, P.R. China.,Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - Shereen Ezzat
- Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Capdevila J, Trigo JM, Aller J, Manzano JL, Adrián SG, Llopis CZ, Reig Ò, Bohn U, Cajal TRY, Duran-Poveda M, Astorga BG, López-Alfonso A, Martínez JM, Porras I, Reina JJ, Palacios N, Grande E, Cillán E, Matos I, Grau JJ. Axitinib treatment in advanced RAI-resistant differentiated thyroid cancer (DTC) and refractory medullary thyroid cancer (MTC). Eur J Endocrinol 2017; 177:309-317. [PMID: 28687563 DOI: 10.1530/eje-17-0243] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/25/2017] [Accepted: 06/29/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Axitinib, an antiangiogenic multikinase inhibitor (MKI), was evaluated in the compassionate use programme (CUP) in Spain (October 2012-November 2014). SUBJECTS AND METHODS 47 patients with advanced radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC, n = 34) or medullary thyroid cancer (MTC, n = 13) with documented disease progression were treated with axitinib 5 mg b.i.d. The primary efficacy endpoint was objective response rate (ORR) by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1. Progression-free survival (PFS) and adverse events (AEs) were secondary objectives. Regulatory authorities validated the CUP, and all patients signed informed consent form. RESULTS Axitinib was administered as first-line therapy in 17 patients (36.2%), as second-line in 18 patients (38.3%) and as third/fourth-line in 12 patients (25.5%). With a median follow-up of 11.5 months (0-24.3), ORR was 27.7% (DTC: 29.4% and MTC: 23.1%) and median PFS was 8.1 months (95% CI: 4.1-12.2) (DTC: 7.4 months (95% CI: 3.1-11.8) and MTC: 9.4 months (95% CI: 4.8-13.9)). Better outcomes were reported with first-line axitinib, with an ORR of 53% and a median PFS of 13.6 months compared with 16.7% and 10.6 months as second-line treatment. Twelve (25.5%) patients required dose reduction to 3 mg b.i.d. All-grade AEs included asthenia (53.2%), diarrhoea (36.2%), hypertension (31.9%) and mucositis (29.8%); grade 3/4 AEs included anorexia (6.4%), diarrhoea (4.3%) and cardiac toxicity (4.3%). CONCLUSION Axitinib had a tolerable safety profile and clinically meaningful activity in refractory and progressive thyroid cancer regardless of histology as first-line therapy. To our knowledge, this is the first time that cross-resistance between MKIs is suggested in thyroid cancer, highlighting the importance of prospective sequential clinical studies.
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Affiliation(s)
- Jaume Capdevila
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Trigo
- Medical Oncology Department, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Javier Aller
- Endocrinology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - José Luís Manzano
- Medical Oncology Department, Catalan Oncology Institute (ICO-Badalona), University Hospital Germans Trias y Pujol, Barcelona, Spain
| | - Silvia García Adrián
- Medical Oncology Department, University Hospital of Móstoles, Móstoles, Madrid, Spain
| | - Carles Zafón Llopis
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Òscar Reig
- Medical Oncology Department, Translational Genomics and Targeted Therapeutics in Solid Tumors (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Uriel Bohn
- Medical Oncology Department, University Hospital of Gran Canaria Doctor Negrín, Las Palmas, Spain
| | - Teresa Ramón Y Cajal
- Medical Oncology Department, University Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Duran-Poveda
- General and Endocrine Surgery Department, University Hospital Rey Juan Carlos, Madrid, Spain
| | | | - Ana López-Alfonso
- Medical Oncology Department, University Hospital Infanta Leonor, Madrid, Spain
| | | | - Ignacio Porras
- Medical Oncology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Juan Jose Reina
- Medical Oncology Department, University Hospital Virgen Macarena, Sevilla, Spain
| | - Nuria Palacios
- Endocrinology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Enrique Grande
- Medical Oncology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Elena Cillán
- Medical Oncology Department, University Hospital of Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignacio Matos
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Jose Grau
- Medical Oncology Department, University of Barcelona, Hospital Clínic of Barcelona, Barcelona, Spain
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Werner TA, Dizdar L, Nolten I, Riemer JC, Mersch S, Schütte SC, Driemel C, Verde PE, Raba K, Topp SA, Schott M, Knoefel WT, Krieg A. Survivin and XIAP - two potential biological targets in follicular thyroid carcinoma. Sci Rep 2017; 7:11383. [PMID: 28900184 PMCID: PMC5595817 DOI: 10.1038/s41598-017-11426-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/17/2017] [Indexed: 12/22/2022] Open
Abstract
Follicular thyroid carcinoma's (FTC) overall good prognosis deteriorates if the tumour fails to retain radioactive iodine. Therefore, new druggable targets are in high demand for this subset of patients. Here, we investigated the prognostic and biological role of survivin and XIAP in FTC. Survivin and XIAP expression was investigated in 44 FTC and corresponding non-neoplastic thyroid specimens using tissue microarrays. Inhibition of both inhibitor of apoptosis proteins (IAP) was induced by shRNAs or specific small molecule antagonists and functional changes were investigated in vitro and in vivo. Survivin and XIAP were solely expressed in FTC tissue. Survivin expression correlated with an advanced tumour stage and recurrent disease. In addition, survivin proved to be an independent negative prognostic marker. Survivin or XIAP knockdown caused a significant reduction in cell viability and proliferation, activated caspase3/7 and was associated with a reduced tumour growth in vivo. IAP-targeting compounds induced a decrease of cell viability, proliferation and cell cycle activity accompanied by an increase in apoptosis. Additionally, YM155 a small molecule inhibitor of survivin expression significantly inhibited tumour growth in vivo. Both IAPs demonstrate significant functional implications in the oncogenesis of FTCs and thus prove to be viable targets in patients with advanced FTC.
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Affiliation(s)
- Thomas A Werner
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Levent Dizdar
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Inga Nolten
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Jasmin C Riemer
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sabrina Mersch
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sina C Schütte
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christiane Driemel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Katharina Raba
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Stefan A Topp
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Matthias Schott
- Division for Specific Endocrinology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Wolfram T Knoefel
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
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Kiyota N, Robinson B, Shah M, Hoff AO, Taylor MH, Li D, Dutcus CE, Lee EK, Kim SB, Tahara M. Defining Radioiodine-Refractory Differentiated Thyroid Cancer: Efficacy and Safety of Lenvatinib by Radioiodine-Refractory Criteria in the SELECT Trial. Thyroid 2017; 27:1135-1141. [PMID: 28665259 PMCID: PMC5646742 DOI: 10.1089/thy.2016.0549] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND While there is a clear consensus for defining radioiodine-refractory differentiated thyroid cancer (RR-DTC), it is unknown whether these criteria are equally valid for determining when radioiodine (RAI) therapy is no longer beneficial and systemic treatment should be considered. Lenvatinib, a multikinase inhibitor, significantly prolonged progression-free survival (PFS) compared to placebo in a Phase 3 trial in RR-DTC (SELECT; hazard ratio [HR]: 0.21 [99% confidence interval (CI) 0.14-0.31]; p < 0.001). This sub-analysis compared clinical outcomes of lenvatinib-treated patients in SELECT stratified by RR-DTC inclusion criteria. METHODS In SELECT, patients with measurable RR-DTC and radiologic evidence of disease progression ≤13 months prior to study entry were randomized 2:1 to lenvatinib (24 mg/day; 28-day cycle) or placebo. In this analysis, patients were stratified based on the following RR-DTC inclusion criteria: no RAI uptake, disease progression within 12 months of RAI therapy despite RAI avidity at the time of treatment, and extensive (>600 mCi) cumulative RAI exposure. All had disease progression as an inclusion criterion for SELECT. RESULTS Of 392 patients (261 lenvatinib; 131 placebo) enrolled, 275, 235, and 73 patients met the inclusion criteria for no RAI uptake, disease progression despite RAI avidity, and extensive RAI exposure, respectively. There was significant overlap between the patient groups, with 167 (42.6%) patients meeting more than one inclusion criterion. Lenvatinib improved median PFS compared to placebo in all groups ("no RAI uptake": lenvatinib not quantifiable [NQ; CI 14.8-NQ] vs. placebo, 3.7 months [CI 2.5-5.3]; "disease progression despite RAI avidity": lenvatinib 16.5 months [CI 12.8-NQ] vs. placebo, 3.7 months [CI 1.9-5.4]; "extensive RAI exposure": lenvatinib 18.7 months [CI 10.7-NQ] vs. placebo, 3.6 months [CI 1.9-5.5]). Objective response rates were 71.8%, 60.0%, and 56.0% for patients with no RAI uptake, disease progression despite RAI avidity, and extensive RAI exposure, respectively. Lenvatinib-related adverse events were similar across groups. CONCLUSIONS Comparable efficacy and safety profiles were observed in lenvatinib-treated patients regardless of RR-DTC criteria, possibly because of a large overlap among patients fulfilling each criterion. However, differing definitions for RR-DTC may be equally valid because both lenvatinib and placebo arms exhibited similar PFS outcomes across groups.
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Affiliation(s)
- Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital and Kobe University Hospital Cancer Center, Kobe, Japan
| | - Bruce Robinson
- Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Manisha Shah
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Ana O. Hoff
- Department of Endocrinology, Endocrine Oncology Unit, Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Matthew H. Taylor
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Di Li
- Eisai, Inc., Woodcliff Lake, New Jersey
| | | | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, South Korea
| | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Makoto Tahara
- Division of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Abstract
OPINION STATEMENT Radioiodine refractory differentiated thyroid cancer (RAI-R DTC) is a challenging malignancy with limited prognosis and treatment options. Recently, clinical trials with targeted therapies have advanced the outlook of these patients, and inhibition of the vascular endothelial growth factor (VEGF) axis has led to the approval of small-molecule tyrosine kinase inhibitors (TKIs) for first-line treatment of radioiodine refractory disease. In addition to approved therapies (sorafenib and lenvatinib), other multi-targeted tyrosine kinase inhibitors that are commercially available have been recognized as viable treatment options for RAI-R DTC. Our preference is to initially use lenvatinib, given the dramatic progression-free survival (PFS) improvement versus placebo, with the caveat that 24 mg daily is not often tolerated and lower doses often used. In patients with BRAF V600E mutation, BRAF inhibitors are now considered for treatment, especially if patients are at high risk from antiangiogenic therapy. Research is continuing to evolve in identifying mechanisms related to radioiodine refractoriness, and trials are evaluating therapeutic molecules to overcome this resistance. Clinical care of patients with RAI-R DTC requires careful consideration of both patient and disease characteristics. Many patients with asymptomatic and indolent disease can be followed for years without treatment while others with high volume or rapidly progressive disease merit early intervention.
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Yin DT, Lei M, Xu J, Li H, Wang Y, Liu Z, Ma R, Yu K, Li X. The Chinese herb Prunella vulgaris promotes apoptosis in human well-differentiated thyroid carcinoma cells via the B-cell lymphoma-2/Bcl-2-associated X protein/caspase-3 signaling pathway. Oncol Lett 2017; 14:1309-1314. [PMID: 28808482 PMCID: PMC5542033 DOI: 10.3892/ol.2017.6317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 02/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prunella vulgaris (PV), a traditional Chinese herb, has been shown to be rich in bioactive chemicals and possess anti-proliferative and pro-apoptotic effects on tumor cells. The effect of PV on human well-differentiated thyroid carcinoma (WDTC), which accounts for the majority of common endocrine malignancies, remains to be elucidated. The present study aimed to investigate the function of PV on WDTC cell lines and apoptosis-associated signaling pathway activity. Additional studies demonstrated that PV may induce apoptosis in WDTC TPC-1 and FTC-133 cell lines, using the Cell Counting Kit-8 assay. Morphological changes of apoptotic cells were observed by Hoechst 33342 and acridine orange/ethidium bromide staining. In addition, ladder pattern of fragmented DNA was observed by DNA gel electrophoresis. It was also observed that PV significantly increased Bcl-2-associated X protein and caspase-3 expression, and downregulated B-cell lymphoma-2 expression in TPC-1 and FTC-133 by reverse transcription-quantitative polymerase chain reaction (P<0.05). Thus, the present results indicated that PV has the potential to be a future WDTC therapeutic agent.
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Affiliation(s)
- De-Tao Yin
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Mengyuan Lei
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Jianhui Xu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Hongqiang Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Yongfei Wang
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Zhen Liu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Runsheng Ma
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Kun Yu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Xianghua Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
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Galli F, Artico M, Taurone S, Manni I, Bianchi E, Piaggio G, Weintraub BD, Szkudlinski MW, Agostinelli E, Dierckx RAJO, Signore A. Radiolabeling of VEGF165 with 99mTc to evaluate VEGFR expression in tumor angiogenesis. Int J Oncol 2017; 50:2171-2179. [PMID: 28498441 DOI: 10.3892/ijo.2017.3989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/27/2017] [Indexed: 01/21/2023] Open
Abstract
Angiogenesis is the main process responsible for tumor growth and metastatization. The principal effector of such mechanism is the vascular endothelial growth factor (VEGF) secreted by cancer cells and other components of tumor microenvironment. Radiolabeled VEGF analogues may provide a useful tool to noninvasively image tumor lesions and evaluate the efficacy of anti-angiogenic drugs that block the VEGFR pathway. Aim of the present study was to radiolabel the human VEGF165 analogue with 99mTechnetium (99mTc) and to evaluate the expression of VEGFR in both cancer and endothelial cells in the tumor microenvironment. 99mTc-VEGF showed in vitro binding to HUVEC cells and in vivo to xenograft tumors in mice (ARO, K1 and HT29). By comparing in vivo data with immunohistochemical analysis of excised tumors we found an inverse correlation between 99mTc-VEGF165 uptake and VEGF histologically detected, but a positive correlation with VEGF receptor expression (VEGFR1). Results of our studies indicate that endogenous VEGF production by cancer cells and other cells of tumor microenvironment should be taken in consideration when performing scintigraphy with radiolabeled VEGF, because of possible false negative results due to saturation of VEGFRs.
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Affiliation(s)
- Filippo Galli
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
| | - Marco Artico
- Department of Sensory Organs, 'Sapienza' University of Rome, Rome, Italy
| | - Samanta Taurone
- Department of Sensory Organs, 'Sapienza' University of Rome, Rome, Italy
| | - Isabella Manni
- SAFU UOSD, Department of Research, Advanced Diagnostics and Technological Innovation, Regina Elena National Cancer Institute, Rome, Italy
| | - Enrica Bianchi
- Department of Sensory Organs, 'Sapienza' University of Rome, Rome, Italy
| | - Giulia Piaggio
- SAFU UOSD, Department of Research, Advanced Diagnostics and Technological Innovation, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Enzo Agostinelli
- Department of Biochemical Sciences 'A. Rossi Fanelli', 'Sapienza' University of Rome, Rome, Italy
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
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Ekpe-Adewuyi E, Lopez-Campistrous A, Tang X, Brindley DN, McMullen TPW. Platelet derived growth factor receptor alpha mediates nodal metastases in papillary thyroid cancer by driving the epithelial-mesenchymal transition. Oncotarget 2016; 7:83684-83700. [PMID: 27845909 PMCID: PMC5347797 DOI: 10.18632/oncotarget.13299] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/22/2016] [Indexed: 01/15/2023] Open
Abstract
Recently platelet derived growth factor receptor-alpha (PDGFRα) was recognized as a potential target to treat aggressive papillary thyroid cancer given its strong association with lymph node metastases. However, it is unclear how PDGFRα potentiates metastases and if it works through the canonical MAPK pathway traditionally linked to PTC oncogenesis. We explored the phenotypic changes driven by PDGFRα activation in human papillary thyroid cancer (PTC) cells and the downstream signalling cascades through which they are effected. We demonstrate that PDGFRα drives an impressive phenotypic change in PTC cell lines as documented by significant cytoskeletal rearrangement, increased migratory potential, and the formation of invadopodia. Cells lacking PDGFRα formed compact and dense spheroids, whereas cells expressing active PDGFRα exhibited invadopodia in three-dimensional culture. To achieve this, active PDGFRα provoked downstream activation of the MAPK/Erk, PI3K/Akt and STAT3 pathways. We further confirmed the role of PDGFRα as a transformative agent promoting the epithelial to mesenchymal transition of PTC cells, through the augmentation of Snail and Slug expression. Crenolanib, a small molecule inhibitor of PDGFRα, suppressed the levels of Snail and Slug and almost completely reversed all the phenotypic changes. We demonstrate that PDGFRα activation is an essential component that drives aggressiveness in PTC cells, and that the signaling pathways are complex, involving not only the MAPK/Erk but also the PI3K/Akt and STAT3 pathways. This argues for upstream targeting of the PDGFRα given the redundancy of oncogenic pathways in PTC, especially in patients whose tumors over-express this tyrosine kinase receptor.
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Affiliation(s)
| | | | - Xiaoyun Tang
- Signal Transduction Research Group, Department of Biochemistry, University of Alberta, Edmonton, Canada
| | - David N. Brindley
- Signal Transduction Research Group, Department of Biochemistry, University of Alberta, Edmonton, Canada
| | - Todd P. W. McMullen
- Department of Surgery, University of Alberta, Edmonton, Canada
- Division of Surgical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
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Abstract
Lenvatinib (Lenvima®) is an oral, multi-targeted tyrosine kinase inhibitor (TKI) of vascular endothelial growth factor (VEGF) receptors 1, 2 and 3, fibroblast growth factor receptors 1, 2, 3 and 4, platelet-derived growth factor receptor alpha, and RET and KIT signalling networks, which are implicated in tumour growth and maintenance. In the EU and USA, lenvatinib is indicated for the treatment of locally recurrent or metastatic progressive, radioiodine-refractory differentiated thyroid cancer (RR-DTC). This approval was based on the results of the randomized, double-blind, multinational, phase 3 SELECT study, in which lenvatinib significantly improved median progression-free survival (PFS) and overall response rate compared with placebo in patients with RR-DTC. The PFS benefit with lenvatinib was seen in all pre-specified subgroups, including patients who had received either one or no prior VEGF-targeted therapy. Moreover, the PFS benefit with lenvatinib was maintained regardless of BRAF or RAS mutation status. The safety and tolerability profile of lenvatinib in SELECT was consistent with that of other VEGF/VEGF receptor-targeted therapies and was mostly manageable. Hypertension was the most common treatment-related adverse event in lenvatinib-treated patients, but only infrequently led to discontinuation of the drug. Although not collected in SELECT, information on quality of life would be useful in assessing the overall impact of therapy on the patient. This notwithstanding, the data which are available indicate that lenvatinib is an effective and generally well-tolerated treatment option for patients with RR-DTC. Lenvatinib, therefore, offers an acceptable alternative to sorafenib--currently, the only other TKI approved for this indication.
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Kawalec P, Malinowska-Lipień I, Brzostek T, Kózka M. Lenvatinib for the treatment of radioiodine-refractory differentiated thyroid carcinoma: a systematic review and indirect comparison with sorafenib. Expert Rev Anticancer Ther 2016; 16:1303-1309. [PMID: 27734713 DOI: 10.1080/14737140.2016.1247697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thyroid carcinoma is the most prevalent endocrine malignancy, with an increasing incidence over the past decades. Treatment of differentiated thyroid cancer consists of surgery followed by radioactive iodine (RAI) ablation of the thyroid remnant, and TSH suppression. Among new therapeutic solutions for patients with advanced RR-DTC stage, the most promising seem to be sorafenib and lenvatinib, up to now considered to be orphan drugs. Areas covered: We performed a systematic review of medical databases to collect all eligible clinical trials referring to the topic of our analysis. Due to the lack of direct clinical trials comparing the drugs we used an adjusted indirect comparison of efficacy and safety of tyrosine kinase inhibitors (TKIs) by Bucher method. Expert commentary: Lenvatinib and sorafenib are drugs with strong evidence on efficacy in treatment of RR-DTC. Based on the currently available clinical data lenvatinib occurred more efficacious then sorafenib in RR-DTC therapy. Safety profile of the drugs was acceptable and comparative. Kinase inhibitors constitute a substantial progress in treatment of advanced thyroid cancer, have achieved long-lasting response and have improved survival without progress of the disease. In the near future we will deal with a range of therapeutic options for patients.
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Affiliation(s)
- Pawel Kawalec
- a Department of Drug Management, Institute of Public Health, Faculty of Health Sciences , Jagiellonian University Medical College , Krakow , Poland
| | - Iwona Malinowska-Lipień
- b Department of Internal and Community Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences , Jagiellonian University Medical College , Krakow , Poland
| | - Tomasz Brzostek
- b Department of Internal and Community Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences , Jagiellonian University Medical College , Krakow , Poland
| | - Maria Kózka
- c Department Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences , Jagiellonian University Medical College , Krakow , Poland
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Obata K, Sugitani I, Ebina A, Sugiura Y, Toda K, Takahashi S, Kawabata K. Common carotid artery rupture during treatment with lenvatinib for anaplastic thyroid cancer. Int Cancer Conf J 2016; 5:197-201. [PMID: 31149454 DOI: 10.1007/s13691-016-0257-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/16/2016] [Indexed: 12/21/2022] Open
Abstract
Anaplastic thyroid cancer is a fatal disease for which no effective therapeutic strategies exist. Lenvatinib, a tyrosine-kinase inhibitor that targets vascular endothelial growth factor receptor, has recently been approved in Japan for the treatment of patients with unresectable thyroid cancer including anaplastic thyroid cancer. Although lenvatinib, like the other tyrosine-kinase inhibitors, sunitinib and sorafenib, might also confer a risk of bleeding, fatal bleeding as a result of lenvatinib treatment for anaplastic thyroid cancer has not been described. A 61-year-old woman presented with a 7-cm mass in the right lobe of the thyroid, lymph node metastases to the neck and multiple lung metastases. Fine needle aspiration revealed that the tumor was anaplastic thyroid cancer. The TNM classification was T4aN1bM1, stage IVC. Shortly after local curative surgery, a tumor recurred in her neck that was treated with lenvatinib (24 mg/day). Nineteen days later, the common carotid artery ruptured and the lenvatinib was stopped. She received the best possible supportive care but died 40 days after stopping the lenvatinib. Autopsy findings showed that the tumor had invaded the adventitia of the common carotid artery at the region of the neck surgery, and an aneurysm had developed. However, the adventitia of the common carotid artery was preserved at the non-dissected area. Lenvatinib might confer risk for fatal bleeding in patients with recurrent anaplastic thyroid cancer after neck surgery, particularly with dissection around the common carotid artery.
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Affiliation(s)
- Kazufumi Obata
- 1Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Iwao Sugitani
- 2Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8602 Japan
| | - Aya Ebina
- 1Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Yoshiya Sugiura
- 3Department of Pathology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Kazuhisa Toda
- 1Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Shunji Takahashi
- 4Division of Medical Oncology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Kazuyoshi Kawabata
- 1Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
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Bikas A, Vachhani S, Jensen K, Vasko V, Burman KD. Targeted therapies in thyroid cancer: an extensive review of the literature. Expert Rev Clin Pharmacol 2016; 9:1299-1313. [PMID: 27367142 DOI: 10.1080/17512433.2016.1204230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Patients with progressive, metastatic, RAI-refractory differentiated thyroid cancer (DTC), as well as patients with advanced medullary (MTC) and anaplastic thyroid cancer represent a cohort for which therapeutic options are limited. The recent discoveries in the molecular mechanisms implicated in TC have provided insight of the pathogenesis and progression of disease. In that respect, targeted therapies have emerged as a promising alternative for the treatment of those patients. Areas covered: Tyrosine Kinase Inhibitors (TKIs) have been studied extensively in TC: sorafenib and lenvatinib have been approved by the FDA for the treatment of metastatic, RAI-refractory DTC, while vandetanib and cabozantinib are FDA approved for use in advanced MTC. Moreover, several additional TKIs, multi-targeted or specific, are currently under investigation in TC. The current manuscript provides an extensive review of the literature regarding targeted therapies in TC including the rationale behind their use, the clinical trials and an expert opinion on their use. Literature in English appearing at PubMed was thoroughly reviewed, especially manuscripts of the last 5 years. Expert commentary: Patients with advanced, progressive, metastatic TC should be evaluated for enrollment in a clinical trial or should be placed on treatment with one of the FDA- and EMA- approved agents.
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Affiliation(s)
- Athanasios Bikas
- a Division of Endocrinology, Department of Medicine , MedStar Washington Hospital Center , Washington , DC , USA
| | - Shivangi Vachhani
- a Division of Endocrinology, Department of Medicine , MedStar Washington Hospital Center , Washington , DC , USA
| | - Kirk Jensen
- b Department of Pediatrics , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Vasyl Vasko
- b Department of Pediatrics , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Kenneth D Burman
- a Division of Endocrinology, Department of Medicine , MedStar Washington Hospital Center , Washington , DC , USA
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Al-Qahtani KH, Tunio MA, Al Asiri M, Fatani H, Bayoumi Y. Calvarium and dura mater as delayed sites of distant metastasis from papillary thyroid carcinoma. Int Med Case Rep J 2015; 8:251-4. [PMID: 26527901 PMCID: PMC4621188 DOI: 10.2147/imcrj.s86183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reported in lung, breast, and prostate malignancies. However, the calvarial and dural metastases from papillary thyroid cancer (PTC) are rare entities and pose diagnostic and therapeutic challenges. To date, only seven cases of calvarial metastasis with intracranial extension from PTC have been reported in literature. However, true dural metastasis from PTC has not yet been reported. Case presentation A 65-year-old Saudi woman presented with 6 months history of painful posterior scalp lump, 7 years after initial diagnosis of PTC. Computed tomography and magnetic resonance imaging showed occipitoparietal calvarial lesion with massive intracranial extension. Another para-sagittal lesion was found at the top of corpus callosum mimicking a meningioma. Histopathology of para-sagittal lesion and the biopsy of calvarial mass confirmed the diagnosis of metastatic PTC. After surgical resection, residual tumors were treated with postoperative intensity-modulated radiation therapy. At 13 months of follow-up, patient was alive and without any signs of recurrence. Conclusion Calvarial and dural metastases from PTC are extremely rare clinical entities. Surgical resection followed by postoperative radiotherapy is the treatment of choice. However, for such cases, multidisciplinary approach can prolong the treatment outcome and survival.
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Affiliation(s)
- Khalid Hussain Al-Qahtani
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mutahir A Tunio
- Radiation Oncology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mushabbab Al Asiri
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hanadi Fatani
- Histopathology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yasser Bayoumi
- Radiation Oncology Department, National Cancer Institute, Cairo, Egypt
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Visciano C, Prevete N, Liotti F, Marone G. Tumor-Associated Mast Cells in Thyroid Cancer. Int J Endocrinol 2015; 2015:705169. [PMID: 26379707 PMCID: PMC4563106 DOI: 10.1155/2015/705169] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/16/2015] [Accepted: 07/15/2015] [Indexed: 12/26/2022] Open
Abstract
There is compelling evidence that the tumor microenvironment plays a major role in mediating aggressive features of cancer cells, including invasive capacity and resistance to conventional and novel therapies. Among the different cell populations that infiltrate cancer stroma, mast cells (MCs) can influence several aspects of tumor biology, including tumor development and progression, angiogenesis, lymphangiogenesis, and tissue remodelling. Thyroid cancer (TC), the most frequent neoplasia of the endocrine system, is characterized by a MC infiltrate, whose density correlates with extrathyroidal extension and invasiveness. Recent evidence suggests the occurrence of epithelial-to-mesenchymal transition (EMT) and stemness in human TC. The precise role of immune cells and their mediators responsible for these features in TC remains unknown. Here, we review the relevance of MC-derived mediators (e.g., the chemokines CXCL1/GRO-α, CXCL10/IP-10, and CXCL8/IL-8) in the context of TC. CXCL1/GRO-α and CXCL10/IP-10 appear to be involved in the stimulation of cell proliferation, while CXCL8/IL-8 participates in the acquisition of TC malignant traits through its ability to induce/enhance the EMT and stem-like features of TC cells. The inhibition of chemokine signaling may offer novel therapeutic approaches for the treatment of refractory forms of TC.
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Affiliation(s)
- Carla Visciano
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, 80131 Naples, Italy
- Institute of Endocrinology and Experimental Oncology (IEOS), CNR, “G. Salvatore”, 80131 Naples, Italy
| | - Nella Prevete
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131 Naples, Italy
- Center for Basic and Clinical Immunologic Research (CISI), University of Naples Federico II, 80131 Naples, Italy
| | - Federica Liotti
- Department of Molecular Medicine and Medical Biotechnology (DMMBM), University of Naples Federico II, 80131 Naples, Italy
- Institute of Endocrinology and Experimental Oncology (IEOS), CNR, “G. Salvatore”, 80131 Naples, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, 80131 Naples, Italy
- Center for Basic and Clinical Immunologic Research (CISI), University of Naples Federico II, 80131 Naples, Italy
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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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49
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Fallahi P, Di Bari F, Ferrari SM, Spisni R, Materazzi G, Miccoli P, Benvenga S, Antonelli A. Selective use of vandetanib in the treatment of thyroid cancer. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:3459-70. [PMID: 26170630 PMCID: PMC4498730 DOI: 10.2147/dddt.s72495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vandetanib is a once-daily orally available tyrosine kinase inhibitor that works by blocking RET (REarranged during Transfection), vascular endothelial growth factor receptor (VEGFR-2, VEGFR-3), and epidermal growth factor receptor and to a lesser extent VEGFR-1, which are important targets in thyroid cancer (TC). It is emerging as a potentially effective option in the treatment of advanced medullary thyroid cancer (MTC) and in dedifferentiated papillary thyroid cancer not responsive to radioiodine. The most important effect of vandetanib in aggressive MTC is a prolongation of progression-free survival and a stabilization of the disease. Significant side effects have been observed with the vandetanib therapy (as fatigue, hypertension, QTc prolongation, cutaneous rash, hand-and-foot syndrome, diarrhea, etc), and severe side effects can require the suspension of the drug. Several studies are currently under way to evaluate the long-term efficacy and tolerability of vandetanib in MTC and in dedifferentiated papillary TC. The efficacy of vandetanib in patients with MTC in long-term treatments could be overcome by the resistance to the drug. However, the effectiveness of the treatment could be ameliorated by the molecular characterization of the tumor and by the possibility to test the sensitivity of primary TC cells from each subject to different tyrosine kinase inhibitor. Association studies are evaluating the effect of the association of vandetanib with other antineoplastic agents (such as irinotecan, bortezomib, etc). Further research is needed to determine the ideal therapy to obtain the best response in terms of survival and quality of life.
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Affiliation(s)
- Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Messina, Messina, Italy
| | | | - Roberto Spisni
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Messina, Messina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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50
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Ferrari SM, Fallahi P, Politti U, Materazzi G, Baldini E, Ulisse S, Miccoli P, Antonelli A. Molecular Targeted Therapies of Aggressive Thyroid Cancer. Front Endocrinol (Lausanne) 2015; 6:176. [PMID: 26635725 PMCID: PMC4653714 DOI: 10.3389/fendo.2015.00176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022] Open
Abstract
Differentiated thyroid carcinomas (DTCs) that arise from follicular cells account >90% of thyroid cancer (TC) [papillary thyroid cancer (PTC) 90%, follicular thyroid cancer (FTC) 10%], while medullary thyroid cancer (MTC) accounts <5%. Complete total thyroidectomy is the treatment of choice for PTC, FTC, and MTC. Radioiodine is routinely recommended in high-risk patients and considered in intermediate risk DTC patients. DTC cancer cells, during tumor progression, may lose the iodide uptake ability, becoming resistant to radioiodine, with a significant worsening of the prognosis. The lack of specific and effective drugs for aggressive and metastatic DTC and MTC leads to additional efforts toward the development of new drugs. Several genetic alterations in different molecular pathways in TC have been shown in the past few decades, associated with TC development and progression. Rearranged during transfection (RET)/PTC gene rearrangements, RET mutations, BRAF mutations, RAS mutations, and vascular endothelial growth factor receptor 2 angiogenesis pathways are some of the known pathways determinant in the development of TC. Tyrosine kinase inhibitors (TKIs) are small organic compounds inhibiting tyrosine kinases auto-phosphorylation and activation, most of them are multikinase inhibitors. TKIs act on the aforementioned molecular pathways involved in growth, angiogenesis, local, and distant spread of TC. TKIs are emerging as new therapies of aggressive TC, including DTC, MTC, and anaplastic thyroid cancer, being capable of inducing clinical responses and stabilization of disease. Vandetanib and cabozantinib have been approved for the treatment of MTC, while sorafenib and lenvatinib for DTC refractory to radioiodine. These drugs prolong median progression-free survival, but until now no significant increase has been observed on overall survival; side effects are common. New efforts are made to find new more effective and safe compounds and to personalize the therapy in each TC patient.
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Affiliation(s)
| | - Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ugo Politti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Enke Baldini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Alessandro Antonelli,
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