1
|
O’Hare P, Cooney T, de Blank P, Gutmann DH, Kieran M, Milde T, Fangusaro J, Fisher M, Avula S, Packer R, Fukuoka K, Mankad K, Mueller S, Waanders AJ, Opocher E, Bouffet E, Raabe E, Werle NE, Azizi AA, Robison NJ, Hernáiz Driever P, Russo M, Schouten N, van Tilburg CM, Sehested A, Grill J, Bandopadhayay P, Kilday JP, Witt O, Ashley DM, Ertl-Wagner BB, Tabori U, Hargrave DR. Resistance, rebound, and recurrence regrowth patterns in pediatric low-grade glioma treated by MAPK inhibition: A modified Delphi approach to build international consensus-based definitions-International Pediatric Low-Grade Glioma Coalition. Neuro Oncol 2024; 26:1357-1366. [PMID: 38743009 PMCID: PMC11300023 DOI: 10.1093/neuonc/noae074] [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: 05/16/2024] Open
Abstract
Pediatric low-grade glioma (pLGG) is the most common childhood brain tumor group. The natural history, when curative resection is not possible, is one of a chronic disease with periods of tumor stability and episodes of tumor progression. While there is a high overall survival rate, many patients experience significant and potentially lifelong morbidities. The majority of pLGGs have an underlying activation of the RAS/MAPK pathway due to mutational events, leading to the use of molecularly targeted therapies in clinical trials, with recent regulatory approval for the combination of BRAF and MEK inhibition for BRAFV600E mutated pLGG. Despite encouraging activity, tumor regrowth can occur during therapy due to drug resistance, off treatment as tumor recurrence, or as reported in some patients as a rapid rebound growth within 3 months of discontinuing targeted therapy. Definitions of these patterns of regrowth have not been well described in pLGG. For this reason, the International Pediatric Low-Grade Glioma Coalition, a global group of physicians and scientists, formed the Resistance, Rebound, and Recurrence (R3) working group to study resistance, rebound, and recurrence. A modified Delphi approach was undertaken to produce consensus-based definitions and recommendations for regrowth patterns in pLGG with specific reference to targeted therapies.
Collapse
Affiliation(s)
- Patricia O’Hare
- Department of Paediatric Oncology, Royal Belfast Hospital for Sick Children, Northern Ireland, UK
| | - Tabitha Cooney
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Broad Institute, Cambridge, Massachusetts, USA
- Day One Biopharmaceuticals, Boston, Massachusetts, USA
| | - Peter de Blank
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Broad Institute, Cambridge, Massachusetts, USA
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark Kieran
- Day One Biopharmaceuticals, Boston, Massachusetts, USA
| | - Till Milde
- Clinical Pediatric Oncology, Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany
- Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Fisher
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Roger Packer
- Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children’s National Hospital, Washington, District of Columbia, USA
| | - Kohei Fukuoka
- Department of Hematology/Oncology, Saitama Children’s Medical Center, Saitama, Japan
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Department of Radiology, London, UK
| | - Sabine Mueller
- Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Angela J Waanders
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Enrico Opocher
- Paediatric Haematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | - Eric Bouffet
- The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eric Raabe
- Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natacha Entz Werle
- Pediatric Onco-Hematology Department, University Hospital of Strasbourg. UMR CNRS 7021, University of Strasbourg, Strasbourg, France
| | - Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine and Comprehensive Centre of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nathan J Robison
- Division of Hematology & Oncology, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Pablo Hernáiz Driever
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, German HIT-LOGGIC-Registry for LGG in children and adolescents, Department of Pediatric Oncology/Hematology, Berlin, Germany
| | - Mark Russo
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Netteke Schouten
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Cornelis M van Tilburg
- Clinical Pediatric Oncology, Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany
- Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Villejuif, France
| | - Pratiti Bandopadhayay
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Broad Institute, Cambridge, Massachusetts, USA
| | - John-Paul Kilday
- The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, and Royal Manchester Children’s Hospital, Manchester, UK
| | - Olaf Witt
- Clinical Pediatric Oncology, Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany
- Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - David M Ashley
- Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center. Pediatric Neuro-Oncology, Preuss Laboratory for Brain Tumor Research, Durham, North Carolina, USA
| | | | - Uri Tabori
- The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Darren R Hargrave
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| |
Collapse
|
2
|
Jiang HJ, Chang YH, Chen YH, Wu CW, Wang PW, Hsiao PJ. Low Dose of Lenvatinib Treatment for Patients of Radioiodine-Refractory Differentiated Thyroid Carcinoma - A Real-World Experience. Cancer Manag Res 2021; 13:7139-7148. [PMID: 34548818 PMCID: PMC8449554 DOI: 10.2147/cmar.s326255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Lenvatinib treatment of 24 mg/day for radioiodine-refractory differentiated thyroid carcinoma (RRDTC) patients was almost intolerable, with high rates of dose reduction, interruption and discontinuation. Balancing treatment safety with disease risks remains challenging, and the appropriate dosage remains unclear in Asia. Patients and Methods A total of 65 RRDTC patients treated with lenvatinib were retrospectively collected from Oct. 2015 to Jun. 2020 from two medical centers of South Taiwan. The drug tolerability, treatment efficacy and clinical outcomes were analyzed. Results Different doses of lenvatinib were initiated but ultimately maintained with a median dose of 10 mg/day within the first 3 months. The disease control rate reached 89.2%, including 24.6% partial response and 64.6% stable disease. Disease progression occurred in 10.8% of patients and increased to 40.0% at the end. Eventually, the treatment dose achieved a median progression-free survival (PFS) of 26.1 months (95% CI: 17.1-NA) with overall survival (OS) not reached yet (24.1~NA). Overall, the 48-month PFS rate was 35.6% (95% CI: 18.5–68.4) and 48-month OS was 54.3% (95% CI: 41.2–71.7). The dose was tolerable with a dose reduction rate of 44.6%, dose interruption rate of 40.0% and fewer high-graded adverse events. The drug discontinuation rate was only 3.1%. However, RRDTC patients with bone metastasis or maximal dose exposure to RAI (≥600 mCi) may have less efficacy to the low maintenance dose treatment. Conclusion Assessing treatment intensity, safety and efficacy, low-dose lenvatinib treatment was well tolerated by RRDTC patients and displayed acceptable drug efficacy and outcomes.
Collapse
Affiliation(s)
- He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-DA DaChang Hospital, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Wen Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine; Department of Nuclear Medicine; Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Pi-Jung Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-DA Hospital; Thyroid Center, E-DA Cancer Hospital; College of Medicine, I-Shou University, Kaohsiung, Taiwan
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kim MH, Lee TH, Lee JS, Lim DJ, Lee PCW. Hif-1α Inhibitors Could Successfully Inhibit the Progression of Differentiated Thyroid Cancer in Vitro. Pharmaceuticals (Basel) 2020; 13:ph13090208. [PMID: 32847004 PMCID: PMC7558478 DOI: 10.3390/ph13090208] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Hypoxia-inducible factor (HIF)-1α plays an important role in cancer progression. In various cancers, including thyroid cancer, overexpression of HIF-1α is related to poor prognosis or treatment response. However, few studies have investigated the role of HIF-1α inhibition in thyroid cancer progression. We evaluated the utility of the HIF-1α inhibitor IDF-11774 in vitro utilizing two thyroid cancer cell lines, K1 and BCPAP. Both cell lines were tested to elucidate the effects of IDF-11774 on cell proliferation and migration using soft agar and invasion assays. Here, we found that a reduction of HIF-1α expression in BCPAP cells was observed after treatment with IDF-11774 in a dose-dependent manner. Moreover, cell proliferation, migration, and anchorage-independent growth were effectively inhibited by IDF-11774 in BCPAP cells but not in K1 cells. Additionally, invasion of BCPAP but not K1 cells was controlled with IDF-11774 in a dose-dependent manner. Our findings suggest that promoting the degradation of HIF-1α could be a strategy to manage progression and that HIF-1α inhibitors are potent drugs for thyroid cancer treatment.
Collapse
Affiliation(s)
- Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea; (M.-H.K.); (J.S.L.)
| | - Tae Hyeong Lee
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Jin Soo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea; (M.-H.K.); (J.S.L.)
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: (D.-J.L.); (P.C.-W.L.); Tel.: +82-2-2045-4249 (P.C.-W.L.)
| | - Peter Chang-Whan Lee
- Department of Biomedical Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
- Correspondence: (D.-J.L.); (P.C.-W.L.); Tel.: +82-2-2045-4249 (P.C.-W.L.)
| |
Collapse
|
5
|
Zhang LL, Liu B, Sun FF, Li HY, Li S, Zhao LR. Papillary thyroid carcinoma with hyperthyroidism and multiple metastases: A case report. Medicine (Baltimore) 2020; 99:e21346. [PMID: 32791734 PMCID: PMC7386968 DOI: 10.1097/md.0000000000021346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to -90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases. PATIENT CONCERNS A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months. DIAGNOSES According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 μIU/mL, thyroid autoantibody: 2.53 IU/L). INTERVENTIONS AND OUTCOMES The patient refused to undergo further intervention or follow-up. LESSONS In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.
Collapse
Affiliation(s)
| | - Bin Liu
- Department of Hand Surgery, The First Hospital of Jilin University, Changchun, China
| | | | | | | | | |
Collapse
|
6
|
Reply to “Missing Skeletal Muscle Metastases of Papillary Thyroid Carcinoma”. Diagnostics (Basel) 2020; 10:diagnostics10070458. [PMID: 32640576 PMCID: PMC7400263 DOI: 10.3390/diagnostics10070458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
|
7
|
Missing Skeletal Muscle Metastases of Papillary Thyroid Carcinoma. Diagnostics (Basel) 2020; 10:diagnostics10070457. [PMID: 32640503 PMCID: PMC7399820 DOI: 10.3390/diagnostics10070457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
|
8
|
Yamazaki H, Sugino K, Matsuzu K, Masaki C, Akaishi J, Hames K, Tomoda C, Suzuki A, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Masuda M, Ito K. Rapid disease progression after discontinuation of lenvatinib in thyroid cancer. Medicine (Baltimore) 2020; 99:e19408. [PMID: 32176066 PMCID: PMC7220477 DOI: 10.1097/md.0000000000019408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11.1% and the median time to occurrence of the flare phenomenon ranged from 7 to 12 days in previous reports. In this study, we investigate the timing and incidence of the flare phenomenon in thyroid cancer patients treated with lenvatinib.The records of patients treated with lenvatinib were retrospectively reviewed. The primary outcomes were the incidence rate and timing of the flare phenomenon after the discontinuation of lenvatinib. The flare phenomenon was defined as death, hospitalization attributable to tumor progression, or unexpected event (e.g., pleural drainage) within 1 month of lenvatinib cessation. We excluded patients with progression of underlying diseases other than thyroid cancer or infection, those in whom the disease progressed, or those who died without achieving a clinical response (stable disease, partial response, or complete response).In total, 8 (14.3%) of the 56 patients experienced the flare phenomenon. The median time from lenvatinib cessation to the flare phenomenon was 9 (range, 4-30) days. Three patients in the flare group died within 1 month of lenvatinib cessation without an imaging evaluation. The remaining 5 patients had dyspnea and pleural effusion, and pleural drainage was performed in 3 of the 5 patients. Lenvatinib was resumed in 4 of the 8 patients in the flare group. Median overall survival (OS) was 15.1 months in the flare group and 41.9 months in the non-flare group. The OS tended to be poor in the flare group than in the non-flare group; however, this difference was not statistically significant (P = .051).In lenvatinib treatment for thyroid cancer, the incidence and timing of the flare phenomenon were similar to those observed with other TKIs. OS tended to be poor in the flare group than in the non-flare group. Further studies are needed to determine the mechanism of the flare phenomenon and establish measures and treatment policies.
Collapse
Affiliation(s)
- Haruhiko Yamazaki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Chie Masaki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Junko Akaishi
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Kiyomi Hames
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Chisato Tomoda
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Akifumi Suzuki
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawaku, Yokohama City, Kanagawa, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo
| |
Collapse
|
9
|
Masaki C, Sugino K, Saito N, Akaishi J, Hames KY, Tomoda C, Suzuki A, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Ito K. Efficacy and Limitations of Lenvatinib Therapy for Radioiodine-Refractory Differentiated Thyroid Cancer: Real-World Experiences. Thyroid 2020; 30:214-221. [PMID: 31854270 DOI: 10.1089/thy.2019.0221] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: The ultimate clinical goal of advanced cancer treatment is improvement of survival. Tyrosine kinase inhibitors (TKIs) were recently approved for radioiodine-refractory differentiated thyroid carcinoma (RR-DTC) that is resistant to conventional therapies since they have significant potential to improve survival in patients who previously had no more treatment strategies available. However, eligible patients are limited in clinical practice, making it difficult to accurately determine the efficacy of TKIs. Patients and Methods: We retrospectively analyzed the efficacy of lenvatinib at a single institution, enrolling 42 RR-DTC patients. Results: The best overall response was partial remission in 26 (62%) patients, stable disease in 10 (24%) patients, and progressive disease (PD) in 6 (14%) patients. The results indicated three-year overall survival (OS) and progression-free survival rates of 51.0% and 32.4%, respectively. Twenty-three (55%) patients had backgrounds that did not match the inclusion criteria of the Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT) trial. Furthermore, PD-experienced patients individually decided whether to continue lenvatinib, and 17 (41%) made the decision themselves; these patients had a three-year OS of 43.0% and postprogression survival (PPS) of 13.3 [95% confidence interval 6.1-not reached] months. Conclusions: Our real-world investigation revealed that patients have wide-ranging background characteristics, and the decision regarding continuation of therapy after PD is based on the patient's general condition. Our management protocol resulted in good PPS. Furthermore, our results indicated equivalent efficacy of lenvatinib as in the SELECT trial. In conclusion, lenvatinib proved effective for RR-DTC patients in a real-world setting.
Collapse
Affiliation(s)
- Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | - Naoko Saito
- Department of Diagnostic Radiology, International Medical Center, Saitama Medical University, Hidaka-City, Japan
| | | | | | | | | | | | | | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | | | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Oh HS, Shin DY, Kim M, Park SY, Kim TH, Kim BH, Kim EY, Kim WB, Chung JH, Shong YK, Lim DJ, Kim WG. Extended Real-World Observation of Patients Treated with Sorafenib for Radioactive Iodine-Refractory Differentiated Thyroid Carcinoma and Impact of Lenvatinib Salvage Treatment: A Korean Multicenter Study. Thyroid 2019; 29:1804-1810. [PMID: 31592739 DOI: 10.1089/thy.2019.0246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Treatment for patients with radioactive iodine (RAI)-refractory differentiated thyroid carcinoma (DTC) is challenging. Recently, two tyrosine kinase inhibitors (sorafenib and lenvatinib) have been approved and showed benefits for progression-free survival with tolerable adverse events. Methods: This is an extension study of a previous multicenter, retrospective cohort study of real-world experience in treating 98 patients with progressive RAI-refractory DTC with sorafenib. The primary endpoint was overall survival (OS). The efficacy of lenvatinib as salvage therapy after disease progression on first-line sorafenib was evaluated by comparing outcomes in 32 patients who were treated with lenvatinib with 41 patients who were not and therefore served as a no salvage treatment group. Results: The median OS of all 98 patients treated with sorafenib was 41.5 months, and the median progression-free survival was 13.5 months. Patients without disease-related symptoms before sorafenib treatment had better OS than those with symptoms (hazard ratio [HR] = 0.56 [95% confidence interval, CI 0.31-0.99], p = 0.048). Larger tumor size was associated with a minimally increased risk of death (HR = 1.02 [CI 1.00-1.03], p = 0.049). Best tumor response was not associated with OS (p = 0.490). Lenvatinib salvage treatment significantly improved OS in patients receiving it compared with those who did not (HR = 0.28 [CI 0.15-0.53], p < 0.001). The median OS from the time of disease progression after first-line sorafenib treatment was 4.9 months in no salvage treatment group, whereas it was not reached in the lenvatinib salvage group. Conclusions: The absence of disease-related symptoms and smaller tumor burden was associated with survival benefits of first-line sorafenib treatment in patients with progressive RAI-refractory DTC. Lenvatinib salvage therapy was effective in improving OS in patients with disease progression after first-line sorafenib.
Collapse
Affiliation(s)
- Hye-Seon Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eui Young Kim
- Department of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Paragliola RM, Corsello A, Del Gatto V, Papi G, Pontecorvi A, Corsello SM. Lenvatinib for thyroid cancer treatment: discovery, pre-clinical development and clinical application. Expert Opin Drug Discov 2019; 15:11-26. [PMID: 31608696 DOI: 10.1080/17460441.2020.1674280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: About one third of patients affected with thyroid cancer present with recurrent disease. Unresectability, advanced disease and radioiodine refractoriness are considered poor prognostic factors. Treatment with small molecules inhibiting molecular signaling can be considered for patients with progressive disease, when other therapeutic strategies cannot be applied. Lenvatinib is a tyrosine kinase inhibitor targeting multiple molecular factors involved in angiogenesis and tumor progression. Preclinical studies have demonstrated the utility of lenvatinib as a targeted therapy for different tumors, including both differentiated and anaplastic thyroid cancer.Areas covered: The authors provide an overview of the preclinical development of lenvatinib in the treatment of thyroid cancer and review its clinical application. They also provide their expert opinion on its development.Expert opinion: Preclinical studies have helped in the understanding of the mechanisms of thyroid carcinogenesis and in the development of a targeted therapy. These findings have represented the rationale for the use of lenvatinib in clinical trials, which have confirmed its utility but yet failed to prove a clear benefit in overall survival. The decision to start a systemic treatment with lenvatinib must be personalized for each patient evaluating the risk/benefits ratio. Treatment emergent adverse events must be considered and reasonably managed by a multidisciplinary approach.
Collapse
Affiliation(s)
- Rosa Maria Paragliola
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corsello
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Del Gatto
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Papi
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Maria Corsello
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
12
|
Uchida T, Yamaguchi H, Nagamine K, Yonekawa T, Nakamura E, Shibata N, Kawano F, Asada Y, Nakazato M. Rapid pleural effusion after discontinuation of lenvatinib in a patient with pleural metastasis from thyroid cancer. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM180158. [PMID: 30884464 PMCID: PMC6432980 DOI: 10.1530/edm-18-0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 01/23/2023] Open
Abstract
We report a case of rapid pleural effusion after discontinuation of lenvatinib. A 73-year-old woman was diagnosed with poorly differentiated thyroid cancer with right pleural metastasis. Weekly paclitaxel treatment was performed for 18 weeks, but it was not effective. Oral administration of lenvatinib, a multi-target tyrosine kinase inhibitor, reduced the size of cervical and thoracic tumors and lowered serum thyroglobulin levels. Lenvatinib was discontinued on day 28 because of Grade 2 thrombocytopenia and Grade 3 petechiae. Seven days after discontinuation of lenvatinib, the patient was hospitalized because of dyspnea and right pleural effusion. Pleural effusion rapidly improved with drainage and re-initiation of lenvatinib and did not recur. Anorexia caused by lenvatinib led to undernutrition, which resulted in death 13 months after initiation of lenvatinib. Autopsy revealed extensive necrosis with primary and metastatic lesions, suggesting that the patient responded to lenvatinib. Physicians should be aware of the possibility of flare-up in patients with thyroid cancer treated with lenvatinib. Learning points: Autopsy findings revealed that lenvatinib was efficacious in treating poorly differentiated thyroid cancer without primary lesion resection. Flare-up phenomenon may occur in thyroid cancer treated with lenvatinib. Attention should be paid to flare-up phenomenon within a few days of discontinuing lenvatinib.
Collapse
Affiliation(s)
- Taisuke Uchida
- Department of Neurology, Respirology, Endocrinology and Metabolism, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideki Yamaguchi
- Department of Neurology, Respirology, Endocrinology and Metabolism, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuhiro Nagamine
- Department of Neurology, Respirology, Endocrinology and Metabolism, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tadato Yonekawa
- Department of Neurology, Respirology, Endocrinology and Metabolism, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eriko Nakamura
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuhiro Shibata
- Department of Clinical Oncology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Fumiaki Kawano
- Division of the Gastrointestinal, Endocrine and Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yujiro Asada
- Department of Diagnostic Pathology, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masamitsu Nakazato
- Department of Neurology, Respirology, Endocrinology and Metabolism, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| |
Collapse
|
13
|
|
14
|
Berdelou A, Lamartina L, Klain M, Leboulleux S, Schlumberger M. Treatment of refractory thyroid cancer. Endocr Relat Cancer 2018; 25:R209-R223. [PMID: 29371330 DOI: 10.1530/erc-17-0542] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/25/2018] [Indexed: 12/22/2022]
Abstract
Distant metastases from thyroid cancer of follicular origin are uncommon. Treatment includes levothyroxine administration, focal treatment modalities with surgery, external radiation therapy and thermal ablation, and radioiodine in patients with uptake of 131I in their metastases. Two-thirds of distant metastases become refractory to radioiodine at some point, and when there is a significant tumor burden and documented progression on imaging, a treatment with a kinase inhibitor may provide benefits.
Collapse
Affiliation(s)
- Amandine Berdelou
- Department of Nuclear Medicine and Endocrine Oncology, TUTHYREF (Tumeurs de la Thyroïde Réfractaires) Network, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Livia Lamartina
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, TUTHYREF (Tumeurs de la Thyroïde Réfractaires) Network, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, TUTHYREF (Tumeurs de la Thyroïde Réfractaires) Network, Gustave Roussy and University Paris-Saclay, Villejuif, France
| |
Collapse
|
15
|
Gild ML, Topliss DJ, Learoyd D, Parnis F, Tie J, Hughes B, Walsh JP, McLeod DSA, Clifton-Bligh RJ, Robinson BG. Clinical guidance for radioiodine refractory differentiated thyroid cancer. Clin Endocrinol (Oxf) 2018; 88:529-537. [PMID: 29095527 DOI: 10.1111/cen.13508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 12/26/2022]
Abstract
Prognosis from differentiated thyroid cancer is worse when the disease becomes refractory to radioiodine. Until recently, treatment options have been limited to local therapies such as surgery and radiotherapy, but the recent availability of systemic therapies now provides some potential for disease control. Multitargeted kinase inhibitors (TKIs) including lenvatinib and sorafenib have been shown to improve progression-free survival in phase III clinical trials, but are also associated with a spectrum of adverse effects. Other TKIs have been utilized as "redifferentiation" agents, increasing sodium iodide symporter expression in metastases and thus restoring radioiodine avidity. Some patients whose disease progresses on initial TKI therapy will still respond to a different TKI and clinical trials currently in progress will clarify the best options for such patients. As these drugs are not inexpensive, care needs to be taken to minimize not only biological but also financial toxicity. In this review, we examine the basic biology of radioiodine refractory disease and discuss optimal treatment approaches, with specific focus on choice and timing of TKI treatment. This clinical field remains fluid, and directions for future research include exploring biomarkers and considering adjuvant TKI use in certain patient groups.
Collapse
Affiliation(s)
- Matti L Gild
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital Sydney, St Leonards, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Duncan J Topliss
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Diana Learoyd
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital Sydney, St Leonards, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Francis Parnis
- Department of Oncology, Adelaide Cancer Centre, Kurralta Park, SA, Australia
- Adelaide University, Adelaide, SA, Australia
| | - Jeanne Tie
- Division of Systems Biology and Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Oncology, Western Health, Melbourne, VIC, Australia
| | - Brett Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia
| | - Donald S A McLeod
- Department of Endocrinology, Diabetes Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Population Health Department QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Roderick J Clifton-Bligh
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital Sydney, St Leonards, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Cancer Genetics Laboratory, Hormones and Cancer Group, Kolling Institute of Medical Research, Sydney, SW, Australia
| | - Bruce G Robinson
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital Sydney, St Leonards, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Cancer Genetics Laboratory, Hormones and Cancer Group, Kolling Institute of Medical Research, Sydney, SW, Australia
| |
Collapse
|
16
|
Herbowski L. Skeletal muscle metastases from papillary and follicular thyroid carcinomas: An extensive review of the literature. Oncol Lett 2018; 15:7083-7089. [PMID: 29731874 PMCID: PMC5920897 DOI: 10.3892/ol.2018.8216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
Skeletal muscle metastasis of papillary or follicular thyroid cancer (PTC/FTC) is a rare finding; only 11 cases of skeletal muscle PTC or FTC metastasis have been included in medical literature reviews. The aim of this study was to identify all published cases of PTC and FTC muscle metastases and derive the true incidence of this malignancy. The probability of detecting the skeletal muscle metastasis of PTC and FTC was calculated based on epidemiological data. Databases of scientific literature on the Internet were searched for articles using relevant key words. The analysis of epidemiological data calculated the probability of detecting skeletal muscle lesions of this type as approximately zero. The literature search revealed 44 published international papers, reporting 58 cases of PTC or FTC skeletal muscle metastasis in 45 patients over 110 years, from 1907 to 2017. The most frequent PTC/FTC metastatic muscle was the gluteus. The majority of cases of muscle metastasis were caused by PTC, and metastatic tumors in the skeletal muscle negatively impacted the survival of patients with PTC or FTC.
Collapse
Affiliation(s)
- Leszek Herbowski
- Neurosurgery and Neurotraumatology Department, District Hospital, 71-455 Szczecin, Poland
| |
Collapse
|
17
|
Smith TJ, Hanna N, Johnson D, Baker S, Biermann WA, Brahmer J, Ellis PM, Giaccone G, Hesketh PJ, Jaiyesimi I, Leighl NB, Riely GJ, Schiller JH, Schneider BJ, Tashbar J, Temin S, Masters G. Case for Stopping Targeted Therapy When Lung Cancer Progresses on Treatment in Hospice-Eligible Patients. J Oncol Pract 2017; 13:780-783. [PMID: 28981389 DOI: 10.1200/jop.2017.027367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas J Smith
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Nasser Hanna
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - David Johnson
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sherman Baker
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - William A Biermann
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Julie Brahmer
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Peter M Ellis
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Giuseppe Giaccone
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Paul J Hesketh
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Ishmael Jaiyesimi
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Natasha B Leighl
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory J Riely
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan H Schiller
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Bryan J Schneider
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Joan Tashbar
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Sarah Temin
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| | - Gregory Masters
- Johns Hopkins, Baltimore, MD; Indiana University, Bloomington, IN; UT Southwestern Medical School, Dallas, TX; Virginia Commonwealth University Massey Cancer Center, Richmond; Inova Schar Cancer Institute, Falls Church; ASCO, Alexandria, VA; Einstein Medical Center, Philadelphia, PA; Juravinski Cancer Centre, Hamilton; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lombardi Cancer Center, Washington, DC; Lahey Hospital & Medical Center, Burlington, MA; William Beaumont Hospital, Royal Oak; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; Circle of Hope for Cancer Research, St Cloud, FL; and Helen F. Graham Cancer Center, Newark, DE
| |
Collapse
|
18
|
White PS, Pudusseri A, Lee SL, Eton O. Intermittent Dosing of Dabrafenib and Trametinib in Metastatic BRAF V600E Mutated Papillary Thyroid Cancer: Two Case Reports. Thyroid 2017; 27:1201-1205. [PMID: 28805135 PMCID: PMC6874808 DOI: 10.1089/thy.2017.0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A multi-institutional, randomized phase II trial of continuous dosing of dabrafenib with or without trametinib is ongoing in metastatic thyroid cancer. Preclinical evidence and emerging clinical experience in other cancers support evaluating intermittent dosing of these two agents to achieve more durable response, while being better tolerated and more cost effective. PATIENTS Two consecutive patients with symptomatic, metastatic radioactive iodine-resistant BRAFV600E mutated papillary thyroid cancer and poor performance status were treated initially with dabrafenib 150 mg twice daily plus trametinib 2 mg once daily, first in continuous daily dosing, then in a five-week-on and three-week-off schedule. RESULTS Both patients showed rapid clinical improvement upon starting the regimen. They also noted improved tolerance of treatment upon transitioning to the intermittent dosing schedule. They continue to show evidence of antitumor activity 27 and 18 months respectively from the start of treatment and 15 and 13 months respectively from the start of the first break using intermittent dosing. CONCLUSIONS Achieving durable palliation in these consecutive patients supports evaluating the intermittent dosing schedule of dabrafenib and trametinib in BRAFV600E mutated papillary thyroid cancer. Results of the ongoing phase 3 trial of continuous daily dosing and a subsequent trial of intermittent dosing, as is being tested in other cancers, will be needed to confirm that an intermittent dosing strategy in thyroid cancer can forestall resistant disease, improve tolerability, and decrease the cost of care.
Collapse
Affiliation(s)
- Paul S. White
- Section of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
| | - Anita Pudusseri
- Section of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
| | - Stephanie L. Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, Massachusetts
| | - Omar Eton
- Section of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
19
|
Pani F, Macerola E, Basolo F, Boi F, Scartozzi M, Mariotti S. Aggressive differentiated thyroid cancer with multiple metastases and NRAS and TERT promoter mutations: A case report. Oncol Lett 2017; 14:2186-2190. [PMID: 28781658 PMCID: PMC5530175 DOI: 10.3892/ol.2017.6395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/26/2017] [Indexed: 11/05/2022] Open
Abstract
Sorafenib, a tyrosine kinase inhibitor, is approved for the treatment of advanced differentiated thyroid carcinoma (DTC). Resistance to sorafenib may appear under treatment and may be associated with increased aggressiveness of the neoplasia. The present study reports the case of a 65-year-old male who underwent total thyroidectomy for a follicular thyroid carcinoma, Hürthle cell variant, in February 2005. Until January 2010, the patient received four consecutive 131I doses (total dose, 612 mCi) for increased serum thyroglobulin (Tg) and initial faint lung uptake (which eventually became undetectable). Subsequently, the patient developed several sequential bone (humerus, rib and skull), adrenal and lung metastases, the majority of which were surgically removed. Histological examination in all cases revealed evidence of DTC metastases that were strongly positive for Tg, as revealed by immunohistochemistry. In March 2014, sorafenib therapy was initiated, but it was discontinued 10 months later to allow an undelayable prostatectomy. Immediately upon surgery, the patient developed a large metastatic lesion in the right gluteal muscle, whose biopsy revealed undifferentiated neoplasia of epithelial origin, and the patient succumbed shortly afterwards. An extensive comparative search for biochemical and molecular markers was performed on all available tissues (primary tumor, and differentiated and undifferentiated metastases). The primary tumor and all the available metastases exhibited the same molecular oncogenic markers (namely, the RAS mutation p.Q61R and the telomerase promoter mutation C228T). In addition, the undifferentiated metastasis exhibited a p53 mutation. The present study reports a case of a sudden acceleration of DTC metastatic progression following sorafenib discontinuation, which could have been due to the emergence of sorafenib-resistant undifferentiated p53-positive tumor cell clones.
Collapse
Affiliation(s)
- Fabiana Pani
- Endocrinology Unit, Department of Medical Sciences 'M. Aresu', University of Cagliari and University Hospital of Cagliari, I-09042 Cagliari, Italy
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa and University Hospital of Santa Chiara, Pisa I-56126, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa and University Hospital of Santa Chiara, Pisa I-56126, Italy
| | - Francesco Boi
- Endocrinology Unit, Department of Medical Sciences 'M. Aresu', University of Cagliari and University Hospital of Cagliari, I-09042 Cagliari, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, Department of Medical Sciences 'M. Aresu', University Hospital of Cagliari and University of Cagliari, I-09042 Cagliari, Italy
| | - Stefano Mariotti
- Endocrinology Unit, Department of Medical Sciences 'M. Aresu', University of Cagliari and University Hospital of Cagliari, I-09042 Cagliari, Italy
| |
Collapse
|
20
|
Tumors Sharply Increased after Ceasing Pazopanib Therapy for a Patient with Advanced Uterine Leiomyosarcoma: Experience of Tumor Flare. Case Rep Obstet Gynecol 2017; 2017:4801650. [PMID: 28484655 PMCID: PMC5397618 DOI: 10.1155/2017/4801650] [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] [Received: 01/19/2017] [Accepted: 03/05/2017] [Indexed: 11/18/2022] Open
Abstract
Pazopanib has activity in patients with soft-tissue sarcoma. We report an advanced uterine leiomyosarcoma case that suddenly worsened after cessation of pazopanib therapy. A 47-year-old woman had a primary uterine leiomyosarcoma tumor and multiple lung metastases, which progressed during her initial treatment. In subsequent treatment with pazopanib for 3 months, the sum of her tumor diameters after cessation sharply increased for two weeks. Symptoms such as dyspnea suddenly worsened also. She died of the disease one month after cessation of pazopanib therapy. Given the poor prognosis of recurrent uterine leiomyosarcoma and the rapid tumor enlargement after ending pazopanib therapy, control of this disease is especially important. Therefore, the decision to discontinue pazopanib therapy requires careful consideration.
Collapse
|
21
|
Kim M, Kim WG, Park S, Kwon H, Jeon MJ, Lee JJ, Ryu JS, Kim TY, Shong YK, Kim WB. Initial Size of Metastatic Lesions Is Best Prognostic Factor in Patients with Metastatic Differentiated Thyroid Carcinoma Confined to the Lung. Thyroid 2017; 27:49-58. [PMID: 27750021 DOI: 10.1089/thy.2016.0347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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 For patients with lung metastases of differentiated thyroid carcinoma (DTC), there is no consensus on the maximal size of metastatic lesions to use when determining the intensity of follow-up and additional therapeutic options. This study evaluated the clinical outcomes and survival of patients with metastatic DTC confined to the lung, using the maximal diameter of lung lesions in the initial computed tomography. METHODS This retrospective cohort study included 112 DTC patients with metastases confined to the lung. The clinical responses were evaluated according to changes in the serum levels of stimulated thyroglobulin or antithyroglobulin antibody, disease status was evaluated according to radiological findings, progression-free survival (PFS), and cancer-specific survival (CSS). RESULTS Macronodular lung metastases (≥1 cm) were observed in 27 (24%) patients, and these patients had significantly poor biochemical responses and disease status (p < 0.001, and p < 0.001, respectively), irrespective of radioactive iodine (RAI) avidity. After adjusting for age, sex, primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, time of lung metastasis, and RAI avidity, the macronodular group also had shorter PFS and CSS (p = 0.009 and p = 0.03, respectively) than the micronodular group. From the multivariate analyses, RAI avidity was not an independent prognostic factor predicting PFS and CSS. In the subgroup analyses, RAI avidity was a significant prognostic factor associated with better PFS and CSS (p = 0.013 and p = 0.021, respectively) in the micronodular group only. CONCLUSIONS The initial largest diameter of metastatic lesions is the most important prognostic factor for predicting poor clinical outcomes and survival in patients with metastatic DTC confined to the lung.
Collapse
Affiliation(s)
- Mijin Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Gu Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suyeon Park
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyemi Kwon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Min Ji Jeon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jong Jin Lee
- 2 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jin-Sook Ryu
- 2 Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae Yong Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Bae Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| |
Collapse
|
22
|
Bruce JY, Scully PC, Carmichael LL, Eickhoff JC, Perlman SB, Kolesar JM, Heideman JL, Jeraj R, Liu G. Pharmacodynamic study of axitinib in patients with advanced malignancies assessed with (18)F-3'deoxy-3'fluoro-L-thymidine positron emission tomography/computed tomography. Cancer Chemother Pharmacol 2015; 76:187-95. [PMID: 26021741 DOI: 10.1007/s00280-015-2779-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/08/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Rapid disease progression associated with increased tumor proliferation has been observed during withdrawal of anti-angiogenic therapy. We characterize the dynamics of withdrawal flare for axitinib. METHODS Thirty patients with metastatic solid malignancies received axitinib for 2 weeks, followed by a 1-week drug holiday. Twenty patients suitable for PET imaging received scans with (18)F-3'deoxy-3'fluoro-L-thymidine (FLT), a marker of proliferation. Plasma VEGF and axitinib pharmacokinetic levels were also assessed at specified time points. RESULTS During axitinib withdrawal, significant increases in both SUVmax (+22 %; p = 0.006) and SUVmean (+20 %; p = 0.001) were observed. Significant increases relative to peak axitinib concentration were observed at day 2 withdrawal for SUVmax and SUVmean, with no further significant increase from day 2 to day 7 of withdrawal. No significant change in SUVmax or SUVmean was observed during the treatment period, relative to baseline. VEGF concentration significantly increased when on drug (p < 0.001) and decreased back to a level indistinguishable from baseline by day 7 of drug washout (p = 0.448). No correlation between change in VEGF and change in imaging metrics was observed. CONCLUSIONS A significant increase in tumor proliferation was observed during withdrawal of axitinib therapy, and this flare occurred within 2 days of axitinib withdrawal. An exploratory analysis indicated that this flare may be associated with poor clinical outcome.
Collapse
Affiliation(s)
- Justine Yang Bruce
- Department of Medicine, University of Wisconsin Carbone Cancer Center, 7105 Wisconsin Institute Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
McLeod DSA, Carruthers K, Kevat DAS. Optimal Differentiated Thyroid Cancer Management in the Elderly. Drugs Aging 2015; 32:283-94. [DOI: 10.1007/s40266-015-0256-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
24
|
Lee WY. Articles in 'endocrinology and metabolism' in 2014. Endocrinol Metab (Seoul) 2015; 30:47-52. [PMID: 25827457 PMCID: PMC4384668 DOI: 10.3803/enm.2015.30.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Won Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
25
|
Schlumberger M, Leboulleux S. Treatment of distant metastases from follicular cell-derived thyroid cancer. F1000PRIME REPORTS 2015; 7:22. [PMID: 25750740 PMCID: PMC4335791 DOI: 10.12703/p7-22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Distant metastases from thyroid cancer of follicular origin are uncommon. Treatment includes levothyroxine administration at suppressive doses, focal treatment modalities with surgery, external radiation therapy and thermal ablation, and radioiodine in patients with uptake of 131I in their metastases. Two thirds of distant metastases will become refractory to radioiodine at some point, and when there is a significant tumor burden and documented progression on imaging, a treatment with a kinase inhibitor may provide benefits.
Collapse
|