scholarly journals Rationale for therapeutic decision-making in locally advanced and metastatic radioactive iodine (RAI)-refractory differentiated thyroid cancer, starting from a clinical case

2021 ◽  
Vol 8 (4) ◽  
pp. 72-83
Author(s):  
Cristina Alina Silaghi ◽  
◽  
Oana Stãnoiu-Pînzariu ◽  
Horaţiu Silaghi ◽  
◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Brain Metastases ◽  
Radioactive Iodine ◽  
Kinase Inhibitors ◽  
Locally Advanced ◽  
Rare Condition ◽  
Progression Free Survival ◽  
Whole Body ◽  
Radioactive Iodine Therapy ◽  
Thyroid Cells

Iodine uptake and organification are the hallmarks of thyroid cells differentiation. The loss of these characteristics in thyroid cancer leads to radioactive iodine refractoriness, a rare condition that bears a low survival rate and poor prognosis. We present a 52-year-old patient presenting dry cough and dyspnea in the supine position. Imaging examinations revealed a thyroid nodule with a high suspicion of malignancy in the right thyroid lobe, multiple laterocervical and mediastinal lymph nodes, lung, bone, and brain metastases. Fine needle aspiration cytologic features have advocated for papillary thyroid cancer (PTC). The patient underwent total thyroidectomy and selective lymphadenectomy. Subsequently, the patient received suppressive treatment with levothyroxine and four courses of radioactive iodine therapy. In addition, to treat bone and brain metastases, the patient experienced external radiotherapy and glucocorticoid therapy. Despite this rigorous therapeutic management, the patient obtained an incomplete structural and functional response. Although the last two posttherapeutic 131I whole-body scans were negative, the patient had elevated stimulated thyroglobulin levels and loco-regional recurrence by thyroid ultrasound. This aspect would suggest that thyroid cells become unable to uptake 131I, most likely through the emergence of new genetic mutations in the cancer cells. In conclusion, our patient's case suggests a 131I-refractory PTC, requiring the initiation of novel targeted systemic agents such as tyrosine kinase inhibitors, in order to improve structural and functional outcomes of radioactive iodine therapy and to afford prolonged progression-free survival advantage.

scholarly journals EFFICACY AND SAFETY OF MULTI-TARGETED KINASE INHIBITORS IN PROGRESSIVE, RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID CANCERS: A META-ANALYSIS

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Mutahir A Tunio ◽  
Mushabbab AlAsiri ◽  
Yasser Bayoumi
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Kinase Inhibitors ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Differentiated Thyroid Cancers ◽  
The Impact

Purpose: A meta-analysis was conducted to evaluate the impact of oral multitargeted kinase inhibitors (MTKIs) in radioactive-iodine refractory locally advanced, recurrent/metastatic differentiated thyroid cancer (DTC) on disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) rates. Materials and Methods: The PubMed/MEDLINE, CANCERLIT, EMBASE, Cochrane Library database and other search engines were searched to identify randomised controlled trials (RCTs) comparing MTKIs with placebo in locally advanced, recurrent/metastatic DTC. Pooled data were expressed as odds ratio (OR), with 95% con dence intervals (CIs, Mantel–Haenszel xed-effect model). Results: Three RCTs with a total patient population of 954 patients were identi ed. The use of MTKIs was associated with improved PFS (OR: 0.262, 95% CI: 0.19–0.35; heterogeneity (I2) = 22.4%; P < 0.0001), improved DCR (complete and partial responses + stable disease, P < 0.0001) and improved OS 0.66, 95% CI: 0.46–0.96 (I2 = 43%, P = 0.034). Lenvatinib (compliance = 87%) was associated with more grade ≥3 hypertension. However, its other adverse effects were much lower than sorafenib (compliance = 56%) and vandetanib. Conclusion: In radioactive iodine-refractory recurrent, metastatic DTC patients, lenvatinib and sorafenib were associated with improved PFS, DRC and OS rates, while the compliance was better with lenvatinib. Key words: Meta-analysis, multitargeted kinase inhibitors, progressive differentiated thyroid cancer, radioactive iodine- refractory 

scholarly journals Brain metastases from differentiated thyroid cancer occurring during and after radioactive iodine therapy: a report of four cases and literature review

2020 ◽  
Author(s):  
Noriko Takata ◽  
Yasushi Hamamoto ◽  
Masao Miyagawa ◽  
Kenji Makita ◽  
Hirofumi Ishikawa ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Lung Metastases ◽  
Radioactive Iodine Therapy ◽  
Major Hemorrhage ◽  
Iodine Dose

Abstract Background Brain metastases from differentiated thyroid cancer are uncommon, and the prognosis of patients with them is poor. To explore the optimal treatment for this entity, we retrospectively investigated incidence and features of brain metastases from differentiated thyroid cancer that appeared during and after radioactive iodine therapy. Methods Between 2002 and 2012, 89 patients of differentiated thyroid cancer were included (median age, 63-years; male/female = 29/60). The median follow-up time from first ablation was 63 months (range: 1–175 months). The median cumulative radioactive iodine dose was 8.51 GBq (range: 1.11–42.55 GBq). Results During the follow-up, brain metastases occurred in four (4.5 %) patients. The median follow-up time after first ablation of four patients was 69 months (22, 63, 76 and 105 months). They had already had extracranial metastases at first ablation (lung metastases: 3, lung and bone metastases: 1), and had one or more lesions resistant to radioactive iodine therapy at diagnosis of brain metastasis. Three of them had experienced major hemorrhage from brain metastasis. Survival time intervals from the diagnosis to brain metastasis were 2.5, 3.6, 13 and 13.1 months. Conclusion Brain metastases of differentiated thyroid cancer were relatively uncommon. Prognosis of patients with brain metastasis was unfavorable because of frequent major brain hemorrhage and frequent existence of concomitant extracranial lesions resistant to radioactive iodine therapy. To prevent intracranial hemorrhage, early treatment seemed to be necessary for brain metastases from differentiated thyroid cancer.

scholarly journals On the role of autophagy in the progression of differentiated thyroid cancer (literature review)

2022 ◽  
Vol 20 (6) ◽  
pp. 134-140
Author(s):  
K. A. Garipov ◽  
Z. A. Afanaseva ◽  
Z. I. Abramova
Keyword(s):  
Thyroid Cancer ◽  
Targeted Therapy ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Kinase Inhibitors ◽  
Radioactive Iodine Therapy ◽  
Effect Of Treatment

The aim of the study was to analyze and summarize available literature data on the role of autophagy in thyroid cancer. Material and methods. We analyzed 34 publications available from pubmed and elibrary. Ru databases concerning thyroid cancer and autophagy. Results. The review discussed the role of autophagy in the progression of thyroid cancer. The development of autophagy-targeted therapy was shown can improve treatment for thyroid cancer. Differentiated thyroid cancer (dtc) is the most common endocrine malignancy. Treatment of dtc patients who are resistant to radioactive iodine therapy is a major challenge. Molecular targeted therapy using tyrosine kinase inhibitors significantly improves treatment outcomes. Conclusion. To enhance the therapeutic effect of treatment with multi-target tyrosine kinase inhibitors, as well as to overcome drug resistance, it is necessary to study the role of autophagy in the development and progression of thyroid cancer.

scholarly journals SUN-485 Combined Treatment with Laser Ablation and Tyrosin Kinase Inhibitors. a Novel Multimodality Approach to Locally Advanced Thyroid Cancer?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Enrico Papini ◽  
Salvatore Monti ◽  
Carmela Coccaro ◽  
Agnese Persichetti ◽  
Federica Presciuttini ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Laser Ablation ◽  
Kinase Inhibitors ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Progressive Increase ◽  
Tumor Burden ◽  
Whole Body ◽  
Laser Source ◽  
Tyrosin Kinase

Abstract Background. Direct loco-regional treatments are considered for local control of cervical metastasis of thyroid cancer. In our feasibility study, laser ablation was employed for initial debulking of an unresectable radioiodine-refractory thyroid cancer in a combined treatment with tyrosin kinase inhibitors (TKI). Clinical case. On June 2016, a 69-year-old woman underwent partial resection of a papillary thyroid cancer with extensive tracheal infiltration. On August 2016, whole body scan performed after 131-I treatment (8140 MBq) demonstrated nearly absent thyroid bed uptake. Due to progressive increase of the cervical mass, the patient experienced dysphonia and dysphagia and, after multidisciplinary consultation, was treated with laser ablation (LTA). After local anesthesia, two 300 nm fiberoptics were inserted into the lesion through 21G spinal needles. Two illuminations with 4-watt output power and 3600 Joules energy delivery were peformed with a diode-laser source. LTA resulted in rapid mass volume decrease (28 x12 x16 mm, 2.8 mL, vs 52 x 29 x 29 mm, 22.7 mL) and improvement of pressure symptoms that lasted 6 months. In May 2017, due to initial regrowth of the tumor mass, the patient started therapy with Lenvatinib, at 10-24 mg/day. The cervical tumor burden remained controlled until April 2019, when occurred rapid disease progression and death of the patient. Discussion. These preliminary results suggest that locally-advanced unresectable and radioiodine-refractory thyroid tumors can be managed with preliminary LTA mass debulking, for rapid control of local disease, followed by long-term TKI treatment. References. Mauri G et al. Cardiovasc Intervent Radiol. 2016 Jul; 39(7):1023-30; Park KW et al. Ann Surg Oncol 2011; 18:2564-2568. Schlumberger M et al. NEJM 2015 12; 372(7):621-30.

scholarly journals Thyroid Cancers: From Surgery to Current and Future Systemic Therapies through Their Molecular Identities

2021 ◽  
Vol 22 (6) ◽  
pp. 3117
Author(s):  
Loredana Lorusso ◽  
Virginia Cappagli ◽  
Laura Valerio ◽  
Carlotta Giani ◽  
David Viola ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Therapeutic Option ◽  
Progression Free Survival ◽  
Thyroid Cancers ◽  
Poorly Differentiated ◽  
Differentiated Thyroid Cancers ◽  
Approved Drugs ◽  
New Generation ◽  
Systemic Therapies

Differentiated thyroid cancers (DTC) are commonly and successfully treated with total thyroidectomy plus/minus radioiodine therapy (RAI). Medullary thyroid cancer (MTC) is only treated with surgery but only intrathyroidal tumors are cured. The worst prognosis is for anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC). Whenever a local or metastatic advanced disease is present, other treatments are required, varying from local to systemic therapies. In the last decade, the efficacy of the targeted therapies and, in particular, tyrosine kinase inhibitors (TKIs) has been demonstrated. They can prolong the disease progression-free survival and represent the most important therapeutic option for the treatment of advanced and progressive thyroid cancer. Currently, lenvatinib and sorafenib are the approved drugs for the treatment of RAI-refractory DTC and PDTC while advanced MTC can be treated with either cabozantinib or vandetanib. Dabrafenib plus trametinib is the only approved treatment by FDA for BRAFV600E mutated ATC. A new generation of TKIs, specifically for single altered oncogenes, is under evaluation in phase 2 and 3 clinical trials. The aim of this review was to provide an overview of the current and future treatments of thyroid cancer with regards to the advanced and progressive cases that require systemic therapies that are becoming more and more targeted on the molecular identity of the tumor.

Combined Treatment with Laser Ablation and Tyrosine-Kinase Inhibitor as a Novel Multimodality Approach to Locally Advanced Thyroid Cancer: a Case Report

2021 ◽  
Vol 21 ◽  
Author(s):  
Agnese Persichetti ◽  
Salvatore Monti ◽  
Carmela Coccaro ◽  
Federica Presciuttini ◽  
Maria Grazia Deiana ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Laser Ablation ◽  
Tyrosine Kinase ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Tumor Burden ◽  
Whole Body ◽  
Laser Source ◽  
Thyroid Tumors ◽  
Multimodality Approach

Background: Direct locoregional treatments were recently proposed for the local control of cervical and distant metastasis of thyroid cancer, but data on their use as part of a multimodality approach for primary thyroid tumors are poor. In this feasibility study, laser ablation (LTA) was successfully used for the initial debulking of unresectable radioiodine-refractory thyroid cancer in sequential therapy with tyrosine-kinase inhibitors (TKI). Clinical case: A 69-year-old woman underwent partial resection of papillary thyroid cancer with extensive tracheal infiltration. Post-treatment whole-body scan (131I, 8140 MBq) showed the absence of cervical thyroid uptake. The patient experienced a rapid increase in her cervical mass associated with dysphonia, dyspnea, and dysphagia. Due to a concomitant severe hypertensive state and cardiac failure, the patient was treated with LTA after a multidisciplinary consultation. After local anesthesia, two 300 nm optic fibers were inserted into the lesion through 21G spinal needles. Two illuminations with 4-watt output power and 3600 Joules energy delivery were performed with a diode-laser source. LTA resulted in rapid cancer debulking, and mass volume decreased from 23.9 to 7.5 mL resulting in significant improvement of pressure symptoms. Three months later, the patient was started on lenvatinib due to the initial regrowth of the tumor mass. The cervical tumor burden was controlled by TKI for 20 months when a rapid disease progression occurred, and the patient died. Discussion: Locally advanced, unresectable, and radioiodine-refractory thyroid tumors can be managed with a novel multimodality approach. The initial debulking with LTA of the locally aggressive disease results in rapid control of the tumor burden threatening patients’ life and is effectively followed by long-term control with TKI treatment. Conclusion: Based on this experience, sequential multimodality treatment with an initial locally directed laser ablation procedure followed by TKI therapy may be considered as a salvage option in patients with unresectable and rapidly progressive RR thyroid tumors.

The Risk of Breast Cancer Is Reduced in Thyroid Cancer Patients after Radioactive Iodine Therapy

2011 ◽  
pp. P3-658-P3-658
Author(s):  
Hwa Young Ahn ◽  
Ah Reum Kang ◽  
Yul Hwang Bo ◽  
Kyung Won Kim ◽  
Young Joo Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thyroid Cancer ◽  
Cancer Patients ◽  
Radioactive Iodine ◽  
Radioactive Iodine Therapy
Sign in / Sign up

Export Citation Format

Share Document