An Unusual Case of Hypopituitarism as an Adverse Effect of Vandetanib and Remission of Breast Metastases in a Patient with Medullary Thyroid Cancer

2021 ◽  
pp. 1-5
Author(s):  
Rosa M. García-Moreno ◽  
Óscar Moreno-Domínguez ◽  
Beatriz Castelo-Fernández ◽  
Laura Yébenes-Gregorio ◽  
Isabel Torres-Sánchez ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Adrenal Insufficiency ◽  
Medullary Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Hypogonadotropic Hypogonadism ◽  
Complete Disappearance ◽  
Secondary Adrenal Insufficiency ◽  
Medullary Thyroid ◽  
Metastatic Lesions ◽  
Breast Metastases

<b><i>Introduction:</i></b> Tyrosine kinase inhibitors have been a breakthrough in the treatment of advanced medullary thyroid cancer (MTC), and they can prolong progression-free survival (PFS). <b><i>Case Presentation:</i></b> A patient with MTC and metastatic spread to the lymph nodes, lungs, bones, breast, and cerebellum started treatment with vandetanib. During treatment, she developed secondary adrenal insufficiency and hypogonadotropic hypogonadism. After 9 years of vandetanib therapy, the disease has not progressed and the patient maintains a complete response of the breast metastases and a partial response of the other metastatic lesions. <b><i>Conclusion:</i></b> To our knowledge, this is the first reported case of secondary adrenal insufficiency and hypogonadotropic hypogonadism related to therapy with vandetanib. Moreover, the prolonged PFS and the complete disappearance of some of the metastatic lesions in this patient are truly unusual.

scholarly journals Increased therapeutic effect on medullary thyroid cancer using a combination of radiation and tyrosine kinase inhibitors

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0233720
Author(s):  
Viktor Sandblom ◽  
Johan Spetz ◽  
Emman Shubbar ◽  
Mikael Montelius ◽  
Ingun Ståhl ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Therapeutic Effect ◽  
Medullary Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Medullary Thyroid

First Line Sorafenib Treatment for Metastatic Medullary Thyroid Cancer: Efficacy and Safety Analysis

2018 ◽  
Vol 127 (04) ◽  
pp. 240-246 ◽  
Author(s):  
Judit Kocsis ◽  
Éva Szekanecz ◽  
Ali Bassam ◽  
Andrea Uhlyarik ◽  
Zsuzsanna Pápai ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Tyrosine Kinase ◽  
Disease Control ◽  
Tyrosine Kinase Inhibitors ◽  
Phase Ii ◽  
Medullary Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Efficacy And Safety ◽  
First Line ◽  
Medullary Thyroid

Abstract Background Medullary thyroid cancer (MTC) is a rare disease, the prognosis of advanced and metastatic disease is poor and few therapeutic options are available in this setting. Based on the results of phase II and III studies with sorafenib in differentiated thyroid cancer and the lack of availability of registered tyrosine kinase inhibitors, vandetabin and cabozantinib in Hungary, we designed a uncontrolled, prospective efficacy and safety study of patients with metastatic MTC treated with first-line sorafenib in five Hungarian oncology centers. Methods Ten consecutive patients with progressive or symptomatic metastatic MTC were included and started sorafenib 400  mg twice a day between June 2012 and March 2016. The primary end point was median progression-free survival (mPFS). Secondary endpoints included disease control rate, biochemical response, symptomatic response and toxicity. Results Four patients achieved partial remission (40%) according to RECIST 1.1 evaluation. Five patients had stable disease beyond 12 months (50%) and one patient had progressive disease (10%). Median PFS was 19.1 months. The disease control rate was 90%. Association between radiologic response and biochemical or symptomatic response was inconsistent. Most common side effects were Grade 1-2 fatigue (60%), palmar-plantar erythrodysesthesia, rash/dermatitis 50-50%, alopecia 40%. Conclusions In our prospective case series in patients with MTC first-line sorafenib showed at least similar efficacy as in other small phase II trials and case reports. Based on comparable efficacy with registered tyrosine kinase inhibitors and it’s manageable toxicity profile, we believe that sorafenib has role in the sequential treatment of MTC.

scholarly journals Multikinase Inhibitors for the Treatment of Progressive, Metastatic Medullary Thyroid Cancer – An Evolving Paradigm

2014 ◽  
Vol 10 (2) ◽  
pp. 145
Author(s):  
Barbara Jarzab ◽  
Jolanta Krajewska ◽  
◽  
Keyword(s):  
Thyroid Cancer ◽  
Growth Factor ◽  
Medullary Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Growth Factor Receptor ◽  
Phase Iii ◽  
Medullary Thyroid ◽  
Modes Of Action ◽  
Phase Iii Trials ◽  
Endothelial Growth Factor

Medullary thyroid cancer (MTC) is an uncommon type of thyroid cancer, representing around 4 % of the all thyroid cancers, and is a challenging malignancy. So far, surgery has been the only curative treatment and until recently there have been no effective medications. Within the past 5 years, multi-targeted kinase inhibitors have emerged that have shown convincing efficacy against such tumours. These drugs have changed the landscape in MTC treatment by providing effective medication for the first time. The modes of action of these drugs differ, but most target RET, a tyrosine kinase shown to play an important role in the pathobiology of MTC, as well as other receptors including vascular endothelial growth factor receptors (VEGFRs), epidermal growth factor receptor (EGFR) and the hepatocyte growth factor receptor MET. Two agents in this class, vandetanib and cabozantinib, have demonstrated efficacy and safety in phase III trials and have consequently received regulatory approval. Other therapies for MTC treatment, including some with similar modes of action, are also in early development.

Effect of sorafenib in symptomatic metastatic medullary thyroid cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14065-14065 ◽  
Author(s):  
F. Kober ◽  
M. Hermann ◽  
A. Handler ◽  
G. Krotla
Keyword(s):  
Thyroid Cancer ◽  
Side Effects ◽  
Tyrosine Kinases ◽  
Medullary Thyroid Cancer ◽  
Serum Levels ◽  
Primary Objective ◽  
Medullary Thyroid ◽  
Severe Diarrhea ◽  
Metastatic Lesions ◽  
Octreotide Therapy

14065 Background: RET receptor tyrosin kinase activity plays a major role in medullary thyroid cancer (MTC) tumor growth. Sorafenib is an oral agent that selectively targets RET tyrosine kinases. Methods: 5 patients (pts) with metastatic MTC with excessive elevation of calcitonin(CTN) serum levels entered this pilotstudy. Hypercalcitonemia-related symptoms were present in all pts (3 severe diarrhea, 2 moderate) and metastasis- related symptoms were present in 4 pts (2 severe pain, 2 moderate). All pts had had prior thyreoidectomy and cervical +- mediastinal lymphnode dissection, 4 pts had prior octreotide therapy, 3 prior chemotherapy. Pts received 800 mg or 400 mg (weight < 50 kg) Sorafenib as a starting dose. According to the protocol, the dose was reduced gradually in 200 mg scale when pts revealed therapy induced side effects to avoid worsening of quality of life. Sorafenib has to be administered at least 3 months, the scheduled duration of therapy was 6 months. Physical examination, calcitonin and CEA levels were monitored every 4 weeks, measurable metastatic lesions were controlled by appropriate means 3 and 6 months after starting therapy. Primary objective was to assess the effect on CTN dependent symptoms, second objectives included assessments of tumor response (RECIST) and biochemical response. Results: After 2–3 months CTN decreased to levels >50% of baseline in all pts, to levels >90% in 2 pts. According to that all pts were free of CTN related symptoms after 4 weeks. In 4 pts CEA levels reacted in a similar way. After 6 months controls of metastatic lesions were classified as CR-1 pt, PR-1 pt, NC-3 pts. 2 pts with severe metastasis-related pain were off analgesics after 3 months of treatment. Due to side effects Sorafenib dosage was reduced to 50% of the initial dose in all patients. Interestingly marked TSH - elevations were observed in 3 pts which indicates a direct influence to the hypothalamic-pituary-axis. Conclusion: Sorafenib has to be considered as an effective teatment of symptomatic, metastatic MTC. No significant financial relationships to disclose.

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