Twenty-two patients (mean age 61) with metastasizing, progressive, nonradioiodine-accumulating thyroid carcinoma of the follicular epithelium were treated with doxorubicin between 2000 and 2005. Tumors were histologically classified as follicular in 15 patients (68%) and papillary in 7 patients (32%). In addition, nine patients (mean age 51 years) with medullary thyroid carcinoma were treated with doxorubicin between 1997 and 2005. Treatment consisted of doxorubicin: either 8 cycles of 15 mg/m2 weekly or 3 cycles of 60 mg/m2 every 3 weeks, repeated once, depending on response and side effects. The effect of therapy was evaluated by radiographic imaging, [18F] FDG-PET, and bone scans. In patients with papillary or follicular thyroid carcinoma, 5% had a partial regression over 6 months, 42% had stable disease for a median of 7 months (range: 1-22), and 53% had continuous progression established over 5 months (range: 1-11). Three patients died before completing chemotherapy. In patients with medullary thyroid carcinoma, 11% had a partial regression over 6 months followed by stable disease for 3 months, 11% had stable disease over 7 months, and 79% demonstrated progressive disease established over 5 months (range: 2-12). Doxorubicin can be a valid chemotherapy option, especially for advanced or metastatic thyroid carcinoma of the follicular epithelium.

Nine patients (mean age 53) with metastasizing, progressive, medullary (MTC), thyroid carcinoma and progressive, nonradioiodine accumulating thyroid carcinoma of the follicular epithelium (follicular carcinoma, FTC and papillary carcinoma, PTC) were treated with a combination of paclitaxel and gemcitabine between 2004 and 2006. Tumors were histologically classified as follicular in 5 patients (56%), as papillary in 2 patients (22%), and medullary in 2 patients (22%). Paclitaxel (90-100 mg/m (2)) and gemcitabine (1,000 mg/m (2)) were applied for two, three, or 6 cycles every three weeks, depending on response and side effects. The effect of therapy was evaluated by radiographic imaging (CT images) and [(18)F]FDG-PET. All patients with papillary, follicular, or medullary thyroid carcinoma had continuous progression during restaging 14.8+/-8.8 weeks after initiation of chemotherapy, including one patient with stable disease after 3 cycles, but continuous progression after 6 cycles of chemotherapy. Paclitaxel and gemcitabine are not a valid chemotherapy option, in particular in patients with progressive, nonradioiodine-accumulating follicular thyroid carcinoma, who were already treated by other chemotherapeutic agents.

Although objective tumor response rates were low, the CVD regimen allowed disease stabilization for a substantial period of time and had acceptable toxicity. After initial surgery, chemotherapy may therefore be considered as a medical treatment option.

We report the first case of a male patient with iodine-induced hyperthyroidism and unstable angina pectoris in whom a diagnostic cardiac catheterization with gadolinium as contrast agent was chosen. The patient was hospitalized with an iodine-induced hyperthyroidism after angioplasty using an iodinated contrast agent. He presented with a continuous arrhythmia and unstable angina pectoris. A repeated cardiac catheterization using iodinated contrast agent was contraindicated. This case report shows that gadolinium is a useful alternative contrast agent for cardiac intervention in patients with iodine-induced hyperthyroidism.

Zusammenfassung ! Bislang waren die medikamentösen therapeutischen Optionen für Patienten mit metastasierten differenzierten (Radiojod-refraktären) oder medullären Schilddrüsenkarzinomen begrenzt. In den letzten Jahren wurden große Fortschritte gemacht, die genetischen Aberrationen, die für die Pathogenese dieser Tumoren ursächlich sind, zu erkennen und funktionell zu verstehen. Basierend auf diesen Erkenntnissen wurden neuere zielgerichtete Krebsmedikamente, sogenannte Kinase-Inhibitoren, für Patienten mit Schilddrüsenkarzinomen im Rahmen klinischer Studien evaluiert. Vor diesem Hintergrund wurde eine selektive Literaturrecherche der MEDLINE-und ASCO-Datenbanken durchgeführt und relevante Studien zu neueren medikamentösen Therapieansätzen bei Schilddrüsenkarzinomen in diesem Übersichtsartikel zusammengefasst. Insbesondere Inhibitoren, die die Signaltransduktion der VEGF-Rezeptorfamilie hemmen, zeigten in Phase-II-Studien bei Patienten mit differenzierten und medullären Schilddrüsenkarzinomen eine eindrucksvolle Wirksamkeit. In diesen Studien wurden objektive Remissionsraten von bis zu 35 % und Krankheitsstabilisierungsraten von weiteren 50 % beobachtet. Das mediane progressionsfreie Überleben lag zwischen 7 und 28 Monaten. Die Ergebnisse dieser Studien belegen, dass diese Kinase-Inhibitoren in der Behandlung von Schilddrüsenkarzinomen eine beachtliche Wirksamkeit aufweisen können. Dennoch sollte der klinische Nutzen dieser teilweise toxischen und kostenintensiven Therapien in Phase-III-Studien überprüft werden, bevor generelle Therapieempfehlungen ausgesprochen werden können. Abstract ! Therapeutic options for patients suffering from metastatic and radioiodine-refractory differentiated and/or medullary thyroid cancer are limited. The clinical benefit of classical chemotherapeutic agents is marginal. Recently, advantages have been made in understanding the molecular pathways that are involved in the pathogenesis of thyroid cancer. Against this background novel agents targeting oncogenic kinases involved in the pathogenesis of thyroid cancer have entered clinical trials. A selective search of Medline and ASCO databases has conducted to identify results of clinical trials using targeted agents for thyroid cancer. Promising results were reported for drugs targeting the VEGF receptor family. Significant clinical activity was observed in these trials with objective responses in 35% and stable disease in an additional 50 % of patients. Median progression-free survival ranged from 7 to 28 months. These results demonstrate clinical activity of several targeted agents in patients with differentiated and/or medullary thyroid cancer. Further investigation of these agents in phase III trials is warranted. Schütt P et al. Zielgerichtete Therapie für… TumorDiagn u Ther 2011; 32: 269 -276 Originalarbeit 269