Volume 6 Supplement 2

4th Congress of the Polish Thyroid Association 2013: abstracts of invited lectures and oral presentations

Open Access

Treatment of advanced thyroid cancer refractory to therapy

  • Barbara Jarząb1
Thyroid Research20136(Suppl 2):A22

DOI: 10.1186/1756-6614-6-S2-A22

Published: 5 April 2013

Radioiodine treatment constitutes the most effective therapeutic option of advanced differentiated thyroid cancer. Unfortunately, about 30% cancers do not show radioiodine uptake or do not respond to therapy.

Thyrosine kinase inhibitors (TKI), among them axitinib, cabozantinib, lenvatinib, motesanib, pazopanib, sorafenib, sunitynib and vandetanib, constitute a new group of drugs implemented to therapy of both differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC). They inhibit growth factor receptors which play crucial role in processes of growth, differentiation and maturation of neoplastic cell. Detailed information related to mechanism of action of each drug as well as to conducted clinical trials are given in the table below:

Table 1

Drug name

Mechanism of action

Clinical trials (phase)

Indications

MOTESANIB

VEGFR1,2,3, PDGFR, c-KIT, RET

II

MTC, DTC

SORAFENIB

B-RAF, VEGFR1, VEGFR2

II/III

MTC

AXITINIB

VEGFR, c-KIT, PDGFR-B

II

DTC

SUNITINIB

VEGFR1, 2, PDGFR, c-KIT, FLT3, RET

II

DTC

LENVATINIB

VEGFR1,2,3, FGFR1 PDGFR

II/III

MTC

CABOZANTINIB

MET, VEGFR2, RET

III

DTC

PAZOPANIB

VEGFR, PDGFR, c-KIT

II

MTC

VANDETANIB

RET, VEGFR, VEGFR2, EGFR

II

DTC

Until now the only registered drug in advanced MTC is vandetanib. Its efficacy has been proved in phase III study. Significant prolongation of progression free survival (PFS) was observed for patients receiving vandetanib compared with placebo group (30.5 months vs. 19 months, respectively). Published results of phase II studies have preliminarily proved the efficacy of axitinib, sorafenib and sunitinib in DTC (beneficial therapeutic effects of partial regression or disease stabilization was noticed in 68%, 76% and 75% cases, respectively). The highest response rate (partial regression) was obtained in DTC patients treated with pazopanib (49%). Whereas, in phase II clinical trials with cabozantynib, motesanib and sorafenib carried out in MTC, disease control was achieved in 90%, 83% and 94% patients, respectively.

The most common side effects are skin reactions such as photosensitivity, rash, hand-food syndrome, arterial hypertension, gastrointestinal – diarrhea, nausea, vomiting, stomatitis and decrease in body weight. Majority of them have slight or moderate intensiveness (G1 and G2 according to Common Terminology Criteria for Adverse Events). The tolerability of TKI is acceptable and does not affect the quality of life.

Authors’ Affiliations

(1)
Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch

Copyright

© Jarzab; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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