Management of recurrent or metastatic thyroid cancer

Recently, vascular endothelial growth factor receptor (VEGFR)-targeted tyrosine kinase inhibitors (TKIs) have become available for the treatment of recurrent or metastatic thyroid cancer. However, a number of clinical challenges that impact the use of VEGFR-targeted TKI in daily clinical practice have arisen. Toxicity is considerable, to the extent that most physicians hesitate to start VEGFR-targeted TKI and prefer to continue a watch-and-wait approach until the patient’s disease markedly worsens. This delayed use of VEGFR-targeted TKI leads to a higher incidence of serious adverse events than was reported in clinical trials. Moreover, the watch-and-wait approach has several demerits, including a worsening of quality of life, worsening of outcomes in patients of older age or with follicular thyroid cancer and increased risk of brain metastasis or bleeding. Thus, optimal timing for the start of VEGFR-targeted TKI requires careful consideration. Moreover, management of VEGFR-targeted TKI toxicities requires appropriate supportive care, well-organised infrastructure in the outpatient clinic and patient education. Future treatment will progress to precision medicine based on molecular testing. Promotion of precision medicine requires the establishment of a system of easy access to molecular testing and the promotion of translational research for the development of new drugs.

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MON-LB79 Do Ultrasound Patterns and Clinical Parameters Modify the Probability of Thyroid Cancer Predicted by Molecular Testing in Thyroid Nodules With Indeterminate Cytology?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2118 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

James J Figge ◽

William E Gooding ◽

Kenneth D Burman ◽

Sarah Mayson ◽

Randall P Scheri ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Predictive Ability ◽

Molecular Testing ◽

Positive Trend ◽

American Thyroid Association ◽

Clinical Parameters ◽

Increased Risk ◽

Indeterminate Cytology ◽

Risk Of Cancer

Abstract Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further modify the risk of cancer in nodules predicted to be positive or negative by molecular testing remains unknown. Aim: To test if clinical parameters, including age, gender, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] system vs American College of Radiology TIRADS), radiation exposure, and family history of thyroid cancer (TC) can modify the probability of TC or NIFTP predicted by MT in thyroid nodules with indeterminate cytology. Methods: We studied 257 thyroid nodules from 10 study centers with fine-needle aspiration (FNA) yielding indeterminate cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression were used for data analysis. Results: In this group of thyroid nodules, out of all parameters studied using univariate regression, patient gender, age, and Bethesda category were significantly associated with TC/NIFTP probability (P<0.05 for each). The ATA US patterns showed a positive trend (P=0.1211), whereas TIRADS was not predictive (P=0.3135). A multivariate regression model incorporating the four most informative covariates (gender, age, Bethesda category, and ATA US patterns) (model #1) yielded a C index=0.653; R2=0.108. Male gender and Bethesda category V significantly increased risk, and age demonstrated a nonlinear risk profile. When TSv3 was added to model #1, the C index increased to 0.888; R2=0.572. However, age (P=0.341), Bethesda category (P=0.272), and the ATA US patterns (P=0.264) had limited predictive ability in comparison with TSv3, which dominated the predictive performance (P<0.001). Gender was the only parameter showing tendency for significance beyond MT (P=0.095). The most parsimonious model incorporated gender and TSv3 (C index=0.889; R2=0.588). Conclusions: While often useful in selecting thyroid nodules for FNA, neither the ATA US nor the TIRADS scoring systems were informative in further predicting TC/NIFTP in thyroid nodules with indeterminate FNA cytology. Although age and Bethesda category were associated with TC/NIFTP probability on univariate analysis, they had limited incremental value above the high predictive ability of TSv3. Gender was the only parameter with potential contribution to predicting TC/NIFTP in addition to MT.

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Abstract #619 Primary Lung Adenocarcinoma in a Sea of Metastatic Thyroid Cancer

Endocrine Practice ◽

10.1016/s1530-891x(20)46963-0 ◽

2019 ◽

Vol 25 ◽

pp. 319-320

Author(s):

Lourdes Rodriguez ◽

Mary Baker ◽

Daniel W Karakla ◽

David Lieb

Keyword(s):

Thyroid Cancer ◽

Lung Adenocarcinoma ◽

Primary Lung Adenocarcinoma ◽

Metastatic Thyroid Cancer

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A case of metastatic thyroid cancer from renal cell cancer with tumor thrombus in the internal jugular vein

Choonpa Igaku ◽

10.3179/jjmu.35.577 ◽

2008 ◽

Vol 35 (5) ◽

pp. 577-578

Author(s):

Eriko TOHNO ◽

Ei UENO ◽

Tohru YASHIRO

Keyword(s):

Thyroid Cancer ◽

Internal Jugular Vein ◽

Renal Cell Cancer ◽

Renal Cell ◽

Tumor Thrombus ◽

Jugular Vein ◽

Cell Cancer ◽

Metastatic Thyroid Cancer

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Faculty Opinions recommendation of A multicenter, phase II trial of everolimus in locally advanced or metastatic thyroid cancer of all histologic subtypes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718113892.793485442 ◽

2013 ◽

Author(s):

Luca Persani

Keyword(s):

Thyroid Cancer ◽

Phase Ii ◽

Phase Ii Trial ◽

Locally Advanced ◽

Multicenter Phase ◽

Histologic Subtypes ◽

Metastatic Thyroid Cancer

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Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

Current Vascular Pharmacology ◽

10.2174/1570161116666180305160116 ◽

2019 ◽

Vol 17 (3) ◽

pp. 298-306 ◽

Cited By ~ 1

Author(s):

Charalambos Vlachopoulos ◽

Dimitrios Terentes-Printzios ◽

Konstantinos Aznaouridis ◽

Nikolaos Ioakeimidis ◽

Panagiotis Xaplanteris ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Beneficial Effect ◽

Harmful Effect ◽

Adverse Outcomes ◽

Intensive Treatment ◽

Serious Adverse Events ◽

Stroke Incidence ◽

Increased Risk ◽

All Cause Mortality

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP). Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome. Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042). Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

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Poorly Differentiated and Anaplastic Thyroid Cancer: Insights into Genomics, Microenvironment and New Drugs

Cancers ◽

10.3390/cancers13133200 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3200

Author(s):

Alessandro Prete ◽

Antonio Matrone ◽

Carla Gambale ◽

Liborio Torregrossa ◽

Elisa Minaldi ◽

...

Keyword(s):

Overall Survival ◽

Thyroid Cancer ◽

Median Overall Survival ◽

Clinical Problem ◽

Anaplastic Thyroid Cancer ◽

New Drugs ◽

Poor Survival ◽

Tumor Microenvironments ◽

Genetic Features ◽

Poorly Differentiated

PDTC and ATC present median overall survival of 6 years and 6 months, respectively. In spite of their rarity, patients with PDTC and ATC represent a significant clinical problem, because of their poor survival and the substantial inefficacy of classical therapies. We reviewed the newest findings about genetic features of PDTC and ATC, from mutations occurring in DNA to alterations in RNA. Therefore, we describe their tumor microenvironments (both immune and not-immune) and the interactions between tumor and neighboring cells. Finally, we recapitulate how this upcoming evidence are changing the treatment of PDTC and ATC.

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Endocrine Disrupting Chemicals and Thyroid Cancer: An Overview

Toxics ◽

10.3390/toxics9010014 ◽

2021 ◽

Vol 9 (1) ◽

pp. 14

Author(s):

Mathilda Alsen ◽

Catherine Sinclair ◽

Peter Cooke ◽

Kimia Ziadkhanpour ◽

Eric Genden ◽

...

Keyword(s):

Thyroid Cancer ◽

Flame Retardants ◽

Endocrine Disrupting Chemicals ◽

National Institutes Of Health ◽

Future Research ◽

National Library ◽

Comprehensive Overview ◽

Carcinogenic Effect ◽

Increased Risk ◽

Endocrine Disrupting

Endocrine disruptive chemicals (EDC) are known to alter thyroid function and have been associated with increased risk of certain cancers. The present study aims to provide a comprehensive overview of available studies on the association between EDC exposure and thyroid cancer. Relevant studies were identified via a literature search in the National Library of Medicine and National Institutes of Health PubMed as well as a review of reference lists of all retrieved articles and of previously published relevant reviews. Overall, the current literature suggests that exposure to certain congeners of flame retardants, polychlorinated biphenyls (PCBs), and phthalates as well as certain pesticides may potentially be associated with an increased risk of thyroid cancer. However, future research is urgently needed to evaluate the different EDCs and their potential carcinogenic effect on the thyroid gland in humans as most EDCs have been studied sporadically and results are not consistent.

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The association between XRCC3 rs1799794 polymorphism and cancer risk: a meta-analysis of 34 case–control studies

BMC Medical Genomics ◽

10.1186/s12920-021-00965-4 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Weiqing Liu ◽

Shumin Ma ◽

Lei Liang ◽

Zhiyong Kou ◽

Hongbin Zhang ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Thyroid Cancer ◽

Cancer Risk ◽

Large Scale ◽

Meta Analysis ◽

Cochrane Library ◽

Cancer Type ◽

Increased Risk ◽

Risk Of Cancer

Abstract Background Studies on the XRCC3 rs1799794 polymorphism show that this polymorphism is involved in a variety of cancers, but its specific relationships or effects are not consistent. The purpose of this meta-analysis was to investigate the association between rs1799794 polymorphism and susceptibility to cancer. Methods PubMed, Embase, the Cochrane Library, Web of Science, and Scopus were searched for eligible studies through June 11, 2019. All analyses were performed with Stata 14.0. Subgroup analyses were performed by cancer type, ethnicity, source of control, and detection method. A total of 37 studies with 23,537 cases and 30,649 controls were included in this meta-analysis. Results XRCC3 rs1799794 increased cancer risk in the dominant model and heterozygous model (GG + AG vs. AA: odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00–1.08, P = 0.051; AG vs. AA: OR = 1.05, 95% CI = 1.00–1.01, P = 0.015). The existence of rs1799794 increased the risk of breast cancer and thyroid cancer, but reduced the risk of ovarian cancer. In addition, rs1799794 increased the risk of cancer in the Caucasian population. Conclusion This meta-analysis confirms that XRCC3 rs1799794 is related to cancer risk, especially increased risk for breast cancer and thyroid cancer and reduced risk for ovarian cancer. However, well-designed large-scale studies are required to further evaluate the results.

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416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

International Psychogeriatrics ◽

10.1017/s1041610220002690 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 132-132

Author(s):

Liliana P. Ferreira ◽

Núria Santos ◽

Nuno Fernandes ◽

Carla Ferreira

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Adverse Events ◽

Mortality Risk ◽

Antipsychotic Treatment ◽

Serious Adverse Events ◽

Risk Of Death ◽

Mesh Terms ◽

Risk Of Mortality ◽

Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

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