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Ying Y, Li H, Xia W, Cheng T, Li H, Fu Q, Ai T, Yang Y, Zhang N, Li X, Ao Q, Du Y, Yang Z. Long-term survival in a patient with metastatic parathyroid carcinoma harboring an EGFR sensitizing mutation: a case report. J Int Med Res 2024; 52:3000605241259669. [PMID: 39053452 PMCID: PMC11283662 DOI: 10.1177/03000605241259669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
Parathyroid carcinoma (PC) is a rare and aggressive endocrine malignancy with limited treatment options. Current treatments such as chemotherapy and radiotherapy have demonstrated limited efficacy. Here, we report the case of a male patient who presented with symptoms including polydipsia, polyuria, and joint pain. Further examination revealed a neck lump, hypercalcemia, and hyperparathyroidism, leading to a diagnosis of PC after en bloc surgery. Seven months later, the patient developed local recurrence and lung metastases, which were resected via left lateral neck dissection and thoracoscopic wedge resection. A 422-gene panel test revealed the presence of epidermal growth factor receptor (EGFR) p.L858R (c. T2573G) mutation, which may sensitize the EGFR-tyrosine kinase inhibitor response, and phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) p.E545KV (c. G1633A) mutation. After multidisciplinary treatment discussions, the patient was treated with the multi-target tyrosine kinase inhibitor, anlotinib, resulting in survival benefits for 19 months. This case highlights the potential of targeted therapy in terms of long-term survival in patients with distant metastatic PC, as well as the importance of precision therapy guided by genome sequencing to identify potential therapeutic targets.
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Affiliation(s)
- Yushi Ying
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Hanning Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Wenfei Xia
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Teng Cheng
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Hui Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Qiang Fu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Tao Ai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Yan Yang
- Division of Endocrinology and Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xingrui Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Qilin Ao
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Yaying Du
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Zhifang Yang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Laboratory of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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Su YJ, Cheng SH, Qian J, Zhang M, Liu W, Zhan XX, Wang ZQ, Liu HD, Zhong XW, Cheng RC. Neoadjuvant therapy with anlotinib in a locally advanced and pulmonary metastasis PTC patient harboring TERT promoter and BRAF V600E mutations: a case report. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000659. [PMID: 37364156 PMCID: PMC10660997 DOI: 10.20945/2359-3997000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/28/2022] [Indexed: 06/28/2023]
Abstract
A 71-year-old woman with recurrent papillary thyroid carcinoma (PTC) was referred to our hospital. A computed tomography scan revealed extensive recurrence in the neck, invading sternocleidomastoid muscle, internal jugular vein, sternal end of the clavicle, strap muscle and skin; and lateral compartment and subclavian lymph nodes were also involved. Multiple pulmonary micrometastases also noticed. The tumor was considered unresectable; however, the patient was unwilling to accept highly invasive surgery. Therefore, we initiated neoadjuvant therapy with anlotinib, 12mg p.o. daily with a 2-week on/1-week off regimen. The tumor shrunk to resectable state after 4 cycles of treatment, and after 3 weeks of withdrawal, successful surgical resection without gross tumor residual was performed. Pathology confirmed as classic PTC harboring coexistent TERT promoter and BRAFV600E mutations by NGS. After anlotinib therapy, apoptosis induction was observed, and proliferation increased, which was due to three weeks of anlotinib withdraw. Structual recurrence was recorded at 6 months after operation due to no further treatment was taken. Our finding suggests that anlotinib could represent as a good treatment option for patients with locally advanced (with or without distant metastasis) PTC; Anlotinib treatment resulted in sufficient reduction of the tumor mass to enable total thyroidectomy and radioactive iodine treatment, providing long-term control of the disease.
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Affiliation(s)
- Yan-Jun Su
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Shao-Hao Cheng
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Jun Qian
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Ming Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Wen Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Xiang-Xiang Zhan
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Zhu-Quan Wang
- Department of General Surgery, The First People's Hospital of Honghe State, Mengzi, PR. China
| | - Hai-Dan Liu
- Department of General Surgery, The First People's Hospital of Honghe State, Mengzi, PR. China
| | - Xing-Wei Zhong
- Department of General Surgery, The First People's Hospital of Honghe State, Mengzi, PR. China,
| | - Ruo-Chuan Cheng
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China,
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Zhang LY, Cai SJ, Liang BY, Yan SY, Wang B, Li MY, Zhao WX. Efficacy of anlotinib combined with radioiodine to treat scalp metastasis of papillary thyroid cancer: A case report and review of literature. World J Clin Cases 2023; 11:2839-2847. [PMID: 37214573 PMCID: PMC10198115 DOI: 10.12998/wjcc.v11.i12.2839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/27/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is one of the well-differentiated thyroid tumors. Cutaneous metastasis from differentiated thyroid cancers occurs in < 1% of primary thyroid carcinomas but produces the worst survival prognosis. The multi-targeting tyrosine kinase inhibitor anlotinib has been approved to treat refractory advanced non-small-cell lung cancer as well as advanced soft-tissue and clear cell sarcomas in China.
CASE SUMMARY In a patient with scalp metastasis caused by PTC, thyroid and skull metastasis tumor sizes were significantly reduced after a trial of neoadjuvant anlotinib therapy for 3 cycles. Anlotinib maintenance medication after thyroidectomy further reduced the metastatic skull tumor size thereby preventing the requirement for craniotomy.
CONCLUSION The outcome of the present trial confirmed the potential of anlotinib therapy to treat scalp metastasis induced by PTC and point the way for the treatment of similar diseases in the future.
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Affiliation(s)
- Li-Yong Zhang
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Shao-Jun Cai
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Bo-Yan Liang
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Shou-Yi Yan
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Bo Wang
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Meng-Yao Li
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Wen-Xin Zhao
- Department of Thyroid Surgery, General Surgery, Minimal Invasive Center, The Training Center for Intraoperative Neurophysiologic Monitoring of Thyroid and Parathyroid, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian Province, China
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