The impact of age and gender on the presentation and prognosis of medullary thyroid cancer - an Israeli multicenter study

Author(s):  
Orit Twito ◽  
Simona Grozinsky-Glasberg ◽  
Carlos Benbassat ◽  
Sigal Llevy ◽  
Gideon Bachar ◽  
...  
2012 ◽  
Vol 97 (6) ◽  
pp. E878-E887 ◽  
Author(s):  
J. Jonklaas ◽  
G. Nogueras-Gonzalez ◽  
M. Munsell ◽  
D. Litofsky ◽  
K. B. Ain ◽  
...  

2016 ◽  
Vol 42 (10) ◽  
pp. 1455-1463 ◽  
Author(s):  
I.J. Nixon ◽  
C. Suárez ◽  
R. Simo ◽  
A. Sanabria ◽  
P. Angelos ◽  
...  

Author(s):  
Victoria Alcazar ◽  
Concepcion Blanco ◽  
Cristina Alvarez-Escola ◽  
Guadalupe Guijarro ◽  
Javier Estrada ◽  
...  

2019 ◽  
Vol 23 (8) ◽  
pp. 1-144 ◽  
Author(s):  
Paul Tappenden ◽  
Christopher Carroll ◽  
Jean Hamilton ◽  
Eva Kaltenthaler ◽  
Ruth Wong ◽  
...  

BackgroundMedullary thyroid cancer (MTC) is a rare form of cancer that affects patients’ health-related quality of life (HRQoL) and survival. Cabozantinib (Cometriq®; Ipsen, Paris, France) and vandetanib (Caprelsa®; Sanofi Genzyme, Cambridge, MA, USA) are currently the treatment modality of choice for treating unresectable progressive and symptomatic MTC.Objectives(1) To evaluate the clinical effectiveness and safety of cabozantinib and vandetanib. (2) To estimate the incremental cost-effectiveness of cabozantinib and vandetanib versus each other and best supportive care. (3) To identify key areas for primary research. (4) To estimate the overall cost of these treatments in England.Data sourcesPeer-reviewed publications (searched from inception to November 2016), European Public Assessment Reports and manufacturers’ submissions.Review methodsA systematic review [including a network meta-analysis (NMA)] was conducted to evaluate the clinical effectiveness and safety of cabozantinib and vandetanib. The economic analysis included a review of existing analyses and the development of a de novo model.ResultsThe systematic review identified two placebo-controlled trials. The Efficacy of XL184 (Cabozantinib) in Advanced Medullary Thyroid Cancer (EXAM) trial evaluated the efficacy and safety of cabozantinib in patients with unresectable locally advanced, metastatic and progressive MTC. The ZETA trial evaluated the efficacy and safety of vandetanib in patients with unresectable locally advanced or metastatic MTC. Both drugs significantly improved progression-free survival (PFS) more than the placebo (p < 0.001). The NMA suggested that, within the symptomatic and progressive MTC population, the effects on PFS were similar (vandetanib vs. cabozantinib: hazard ratio 1.14, 95% credible interval 0.41 to 3.09). Neither trial demonstrated a significant overall survival benefit for cabozantinib or vandetanib versus placebo, although data from ZETA were subject to potential confounding. Both cabozantinib and vandetanib demonstrated significantly better objective response rates and calcitonin (CTN) and carcinoembryonic antigen (CEA) response rates than placebo. Both cabozantinib and vandetanib produced frequent adverse events, often leading to dose interruption or reduction. The assessment group model indicates that, within the EU-label population (symptomatic and progressive MTC), the incremental cost-effectiveness ratios (ICERs) for cabozantinib and vandetanib are > £138,000 per quality-adjusted life-year (QALY) gained. Within the restricted EU-label population (symptomatic and progressive MTC with CEA/CTN doubling times of ≤ 24 months), the ICER for vandetanib is expected to be > £66,000 per QALY gained. The maximum annual budget impact within the symptomatic and progressive population is estimated to be ≈£2.35M for cabozantinib and ≈£5.53M for vandetanib. The costs of vandetanib in the restricted EU-label population are expected to be lower.LimitationsThe intention-to-treat populations of the EXAM and ZETA trials are notably different. The analyses of ZETA subgroups may be subject to confounding as a result of differences in baseline characteristics and open-label vandetanib use. Attempts to statistically adjust for treatment switching were unsuccessful. No HRQoL evidence was identified for the MTC population.ConclusionsThe identified trials suggest that cabozantinib and vandetanib improve PFS more than the placebo; however, significant OS benefits were not demonstrated. The economic analyses indicate that within the EU-label population, the ICERs for cabozantinib and vandetanib are > £138,000 per QALY gained. Within the restricted EU-label population, the ICER for vandetanib is expected to be > £66,000 per QALY gained.Future research priorities(1) Primary research assessing the long-term effectiveness of cabozantinib and vandetanib within relevant subgroups. (2) Reanalyses of the ZETA trial to investigate the impact of adjusting for open-label vandetanib use using appropriate statistical methods. (3) Studies assessing the impact of MTC on HRQoL.Study registrationThis study is registered as PROSPERO CRD42016050403.FundingThe National Institute for Health Research Health Technology Assessment programme.


2020 ◽  
Vol 9 (7) ◽  
pp. 2316 ◽  
Author(s):  
Andreea Bojoga ◽  
Anna Koot ◽  
Johannes Bonenkamp ◽  
Johannes de Wilt ◽  
Joanna IntHout ◽  
...  

Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61–1.96, I2 = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99–1.00, I2 = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89–1.03, I2 = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00–1.01, I2 = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.


2006 ◽  
Vol 10 (5) ◽  
pp. 571-575 ◽  
Author(s):  
Erika L. Keatts ◽  
Joanne Itano

2018 ◽  
Vol 24 ◽  
pp. 273-274
Author(s):  
Corin Badiu ◽  
Mara Baet ◽  
Ruxandra Dobrescu ◽  
Andra Caragheorgheopol ◽  
Corneci Cristina

1986 ◽  
Vol 25 (06) ◽  
pp. 227-231 ◽  
Author(s):  
Chr. Eilles ◽  
W. Spiegel ◽  
W. Becker ◽  
W. Börner ◽  
Chr. Reiners

The monoclonal anti-CEA F(ab’)2 fragment MAb BW 431/31, labelled with 123I or111 In, was used for immunoscintigraphy (IS) in 9 patients with medullary cancer of the thyroid (CCC). The results of 11 studies lead to the following conclusions: 1) When using radioiodine as a label for MAb in IS, potassium iodide is absolutely necessary to block the thyroid which is of special importance in patients with thyroid cancer; 2) Preinjection of “cold” MAb reduces the relatively high unspecific uptake (especially in bone marrow) of MAb BW 431/31, which is of special importance for the antibody labelled with 111 In; 3) IS with MAb BW 413/31 in patients with CCC and elevated serum CEA is positive only in cases with large secondaries; and 4) In patients with CCC and several manifestations of secondaries, only a single (large) metastasis may be apparent.


2014 ◽  
Author(s):  
Malgorzata Oczko-Wojciechowska ◽  
Michal Swierniak ◽  
Malgorzata Kowalska ◽  
Agnieszka Pawlaczek ◽  
Monika Kowal ◽  
...  

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