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Cabanillas ME, Ryder M, Jimenez C. Targeted Therapy for Advanced Thyroid Cancer: Kinase Inhibitors and Beyond. Endocr Rev 2019; 40:1573-1604. [PMID: 31322645 PMCID: PMC7341904 DOI: 10.1210/er.2019-00007] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
The treatment of advanced thyroid cancer has undergone rapid evolution in the last decade, with multiple kinase inhibitor drug approvals for each subtype of thyroid cancer and a number of other commercially available drugs that have been studied for this indication. Although most of the US Food and Drug Administration (FDA)-approved drugs are antiangiogenic multikinase inhibitors-vandetanib, cabozantinib, sorafenib, lenvatinib-there are two FDA indications that are mutation specific-dabrafenib/trametinib for BRAF-mutated anaplastic thyroid cancer and larotrectinib for NTRK-fusion thyroid cancer. Furthermore, other mutation-specific drugs, immunotherapies, and novel strategies for advanced thyroid cancer are under investigation. Understanding the molecular basis of thyroid cancer, the drugs of interest for treatment of advanced thyroid cancer, and how these drugs can be administered safely and in the appropriate clinical scenario are the topics of this review.
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Affiliation(s)
- Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mabel Ryder
- Department of Endocrinology and Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sabra MM, Sherman E, Tuttle RM. Prolongation of tumour volume doubling time (midDT) is associated with improvement in disease-specific survival in patients with rapidly progressive radioactive iodine refractory differentiated thyroid cancer selected for molecular targeted therapy. Clin Endocrinol (Oxf) 2019; 90:617-622. [PMID: 30706513 PMCID: PMC6761925 DOI: 10.1111/cen.13941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess molecular targeted therapy (MTT)'s ability to affect tumour volume doubling time (TVDT) and disease-specific survival (DSS) in patients presenting with lung metastasis from radioactive iodine refractory progressive thyroid cancer. METHODS In this retrospective study, we examined the clinical characteristics, average tumour volume doubling times of lung metastasis and disease-specific survival of patients with lung metastasis from differentiated thyroid cancer who were treated with MTT. RESULTS The 5-year DSS from the distant metastasis (DM) diagnosis was 72% with median survival of 8 years (95% CI: 6.6-9.5). The median survival was 2.9 years after MTT start (95% CI: 2.1-3.6). On MTT, lung average tumour volume doubling time (midDT) was prolonged to midDT ≥3 years in 75% of patients with baseline midDT ≤1 year and 100% of patients with midDT 1-3 years. In patients with rapidly progressive thyroid cancer (midDT ≤1 year at baseline), the median survival was 4.5 years in those with MTT-achieved midDT ≥3 years (95% CI: 2.9-6.2), as opposed to 2.3 years (95% CI: 0.3-4.3) and 0.7 years (95% CI: 0.2-1.3) in those with MTT-achieved midDT of 1-3 years and MTT-achieved midDT ≤1 year, respectively (log rank P < 0.001). CONCLUSION Lung midDT is a useful and important clinical marker of disease-specific survival for patients with progressive radioactive iodine refractory (RAIR) metastatic thyroid cancer. In patients with rapidly progressive metastatic RAIR thyroid cancer, molecular targeted therapy prolongs lung tumour volume doubling time and is associated with improved disease-specific survival.
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Affiliation(s)
- Mona M. Sabra
- Department of Medicine,Endocrinology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Head and Neck Medical Oncology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, NY, USA
| | - R. Michael Tuttle
- Department of Medicine,Endocrinology Service, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, NY, USA
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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, Terris DJ, Sabra MM. Information for Clinicians: Approach to the Patient with Progressive Radioiodine-Refractory Thyroid Cancer-When to Use Systemic Therapy. Thyroid 2017. [PMID: 28635520 DOI: 10.1089/thy.2016.0578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Terris
- Department of Otolaryngology and Division of Endocrinology, Department of Medicine, Augusta University, Augusta, Georgia
| | - Mona M Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill-Cornell College of Medicine, New York, New York
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Rosenthal MS, Ain KB, Angelos P, Hatanaka R, Motojima M. Problematic clinical trials in thyroid cancer: the issue of papillary carcinoma and observational approaches. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017. [DOI: 10.2217/ije-2017-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We describe the clinical ethics problem of American thyroid cancer patients being offered ‘observation’ instead of the USA standard of care with questionable informed consent. This problem arose because some American practitioners misinterpreted 1990s Japanese studies. American proponents of these studies failed to recognize major differences in ethical oversight between Japanese and US clinical research, misrepresenting these studies as justifying clinical practices for higher risk patients that were not supported by data. The current professional environment in American thyroid cancer management is sufficiently problematic that consideration should be made, for patients who have inadvertently consented to nonevidence-based treatments, to be recontacted and provided an opportunity to revisit their care plans or seek second opinions regarding an observational approach.
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Affiliation(s)
- M Sara Rosenthal
- University of Kentucky Program for Bioethics, Medical Science Building, MS-581, University of Kentucky, Lexington, KY 40536, USA
| | - Kenneth B Ain
- Department of Internal Medicine & Thyroid Cancer Research Laboratory, University of Kentucky Thyroid Oncology Program, VA Medical Center, Lexington, KY 40536, USA
| | - Peter Angelos
- University of Chicago Department of Surgery & MacLean Center for Clinical Medical Ethics, 5841 S Maryland Ave, MC 4052, Chicago, IL 60637, USA
| | - Ryoko Hatanaka
- Institute of Gerontology, The University of Tokyo, Faculty of Engineering Bldg 8, #713 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8656, Japan
- Sau Po Centre on Ageing, The University of Hong Kong 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong
| | - Masaru Motojima
- Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, 259-1193, Japan
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8739] [Impact Index Per Article: 1092.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Ain KB. Radioiodine-remnant ablation in low-risk differentiated thyroid cancer: pros. Endocrine 2015; 50:61-6. [PMID: 26109472 DOI: 10.1007/s12020-015-0668-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/13/2015] [Indexed: 12/17/2022]
Abstract
Differentiated thyroid carcinomas are typically treated with total thyroidectomy as initial therapy. Subsequent radioactive iodine (RAI) ablation destroys post-surgical thyroid remnants, can additionally provide adjuvant therapy of residual and metastatic thyroid cancers, and enhances the sensitivity and specificity of further diagnostic studies. There is current controversy regarding whether a large number of patients, broadly considered to have "low-risk" disease, should be provided RAI ablation. This is consequent to over-reliance on short-term studies, under-appreciation of the value of RAI remnant ablation, and inflation of the side effects of RAI therapy. A balanced assessment of all of these issues provides justification to utilize post-surgical radioiodine ablation, even in cases that are considered low risk on the basis of surgical findings.
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Affiliation(s)
- Kenneth B Ain
- Thyroid Oncology Program, Markey Cancer Center, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA,
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