Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos de Endocrinologia e Metabolismo (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972017000100081 |
Resumo: | ABSTRACT Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them. |
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Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situationDifferentiated thyroid cancerradioactive iodine refractory thyroid cancertyrosine kinase inhibitorsABSTRACT Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them.Sociedade Brasileira de Endocrinologia e Metabologia2017-02-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972017000100081Archives of Endocrinology and Metabolism v.61 n.1 2017reponame:Arquivos de Endocrinologia e Metabolismo (Online)instname:Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)instacron:SBEM10.1590/2359-3997000000245info:eu-repo/semantics/openAccessSchmidt,AngelicaIglesias,LauraKlain,MichelePitoia,FabiánSchlumberger,Martin J.eng2017-02-20T00:00:00Zoai:scielo:S2359-39972017000100081Revistahttps://www.aem-sbem.com/https://old.scielo.br/oai/scielo-oai.php||aem.editorial.office@endocrino.org.br2359-42922359-3997opendoar:2017-02-20T00:00Arquivos de Endocrinologia e Metabolismo (Online) - Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)false |
dc.title.none.fl_str_mv |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
title |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
spellingShingle |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation Schmidt,Angelica Differentiated thyroid cancer radioactive iodine refractory thyroid cancer tyrosine kinase inhibitors |
title_short |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
title_full |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
title_fullStr |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
title_full_unstemmed |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
title_sort |
Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation |
author |
Schmidt,Angelica |
author_facet |
Schmidt,Angelica Iglesias,Laura Klain,Michele Pitoia,Fabián Schlumberger,Martin J. |
author_role |
author |
author2 |
Iglesias,Laura Klain,Michele Pitoia,Fabián Schlumberger,Martin J. |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Schmidt,Angelica Iglesias,Laura Klain,Michele Pitoia,Fabián Schlumberger,Martin J. |
dc.subject.por.fl_str_mv |
Differentiated thyroid cancer radioactive iodine refractory thyroid cancer tyrosine kinase inhibitors |
topic |
Differentiated thyroid cancer radioactive iodine refractory thyroid cancer tyrosine kinase inhibitors |
description |
ABSTRACT Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-02-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972017000100081 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972017000100081 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/2359-3997000000245 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Endocrinologia e Metabologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Endocrinologia e Metabologia |
dc.source.none.fl_str_mv |
Archives of Endocrinology and Metabolism v.61 n.1 2017 reponame:Arquivos de Endocrinologia e Metabolismo (Online) instname:Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) instacron:SBEM |
instname_str |
Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) |
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SBEM |
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SBEM |
reponame_str |
Arquivos de Endocrinologia e Metabolismo (Online) |
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Arquivos de Endocrinologia e Metabolismo (Online) |
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Arquivos de Endocrinologia e Metabolismo (Online) - Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) |
repository.mail.fl_str_mv |
||aem.editorial.office@endocrino.org.br |
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1752122514978373632 |