Neoadjuvant Therapy in Differentiated Thyroid Cancer

Dang, Rajan P.; McFarland, Daniel C.; Le, Valerie H.; Camille, Nadia; Miles, Brett A.; Teng, Marita S.; Genden, Eric M.; Misiukiewicz, Krzysztof

doi:10.1155/2016/3743420

Cited by 13 publications

(9 citation statements)

References 44 publications

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“…Indication of induction chemotherapy in inoperable DTC is not well established (9). Retrospective nonrandomized studies reported the benefit of cytotoxic agents in locally invasive follicular and papillary carcinomas prior to surgery (10,11).…”

Section: Discussionmentioning

confidence: 99%

Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer

Danilovic¹,

Castro²,

Roitberg³

et al. 2018

Archives of Endocrinology and Metabolism

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Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.

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Section: Discussionmentioning

confidence: 99%

Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer

Danilovic¹,

Castro²,

Roitberg³

et al. 2018

Archives of Endocrinology and Metabolism

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“…Other opportunities for redifferentiation of follicular cells and re- There are no studies with adjuvant TKI use in DTC, and very few with neoadjuvant chemotherapy. 64 As we begin to understand more about rapid tumour inhibition, this may become an option in selected populations when emerging data become available.…”

Section: Future Directionsmentioning

confidence: 99%

Clinical guidance for radioiodine refractory differentiated thyroid cancer

Gild

Topliss

Learoyd

et al. 2017

Clinical Endocrinology

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Prognosis from differentiated thyroid cancer is worse when the disease becomes refractory to radioiodine. Until recently, treatment options have been limited to local therapies such as surgery and radiotherapy, but the recent availability of systemic therapies now provides some potential for disease control. Multitargeted kinase inhibitors (TKIs) including lenvatinib and sorafenib have been shown to improve progression-free survival in phase III clinical trials, but are also associated with a spectrum of adverse effects. Other TKIs have been utilized as "redifferentiation" agents, increasing sodium iodide symporter expression in metastases and thus restoring radioiodine avidity. Some patients whose disease progresses on initial TKI therapy will still respond to a different TKI and clinical trials currently in progress will clarify the best options for such patients. As these drugs are not inexpensive, care needs to be taken to minimize not only biological but also financial toxicity. In this review, we examine the basic biology of radioiodine refractory disease and discuss optimal treatment approaches, with specific focus on choice and timing of TKI treatment. This clinical field remains fluid, and directions for future research include exploring biomarkers and considering adjuvant TKI use in certain patient groups.

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“…The results showed comparable response rates with a decrease in tumor size in both FTC and PTC (45% and 44% respectively) [9,10]. Dang et al, reviewed the effects of neoadjuvant chemotherapy in reducing morbid or complicated surgical resection [11]. Despite a few trials which showed beneficial results in locally invasive disease, the data had several limitations and neoadjuvant chemotherapy is not currently recommended [11].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic options for advanced thyroid cancer

Jayarangaiah

Sidhu

Brown

et al. 2019

Int J Clin Endocrinol Metab

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Thyroid cancer can be largely classified as well-differentiated, poorly differentiated, medullary and anaplastic. Differentiated thyroid cancer (DTC) includes follicular and papillary subtypes, with the incidence of papillary thyroid cancer (PTC) on the rise. The mainstay of treatment for DTC includes a combination of surgery, radioactive iodine (RAI) and levothyroxine suppression. DTC portends a favorable prognosis, even in the presence of distant metastases, with a 50% rate of 5-year survival largely due to tumor cell’s sensitivity to RAI therapy influencing disease outcome. In radioactive iodine refractory differentiated thyroid cancer (RAI-refractory DTC) there is a lower survival rate prompting the use of other therapeutic options available. RAI refractoriness is more common in older patients (age >40), large metastases and lesions that are fluorodeoxyglucose (FDG) avid on position emission tomography (PET). Over the past decade, Identification of genetic mutations in the signaling pathway involved in thyroid tumorigenesis has led to the approval of tyrosine kinase inhibitors (TKIs); Sorafenib and Lenvatinib in RAI-refractory DTC. Similarly, metastatic medullary thyroid cancer (MTC) implies an unfavorable 10-year survival rate of only 20% as the principal treatment options focuses on loco regional control via surgical and/or non-surgical options. The approval of TKIs such as Cabozantinib and Vandetanib has introduced an encouraging, novel, systemic therapeutic option for metastatic MTC. Lastly, anaplastic thyroid cancer (ATC) carries the worst prognosis with high recurrence rates. Treatment includes surgery, chemotherapy and external beam radiation. The FDA recently approved Dabrafenib plus trametinib for BRAF V600E mutated ATC. Considering the modality of chemotherapy and the expanding field of targeted therapies, the role of the oncologist and interaction with endocrinologist in the management of thyroid cancer needs further clarification aiming at collaborative management plans more than ever. This review summarizes the key phase III trials that led to the approval of TKIs in the treatment of DTC and metastatic MTC. Additionally, the review aims to clarify the patient selection criteria for initiation of TKIs and examine the implications, considerations and adverse effects prior to utilizing targeted therapy. Clinical trials are ongoing with promising results and may contribute to the addition of several targeted molecules and immune check point inhibitors to the therapeutic armamentarium for RAI-refractory DTC, medullary and anaplastic thyroid cancer.

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Neoadjuvant Therapy in Differentiated Thyroid Cancer

Cited by 13 publications

References 44 publications

Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer

Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer

Clinical guidance for radioiodine refractory differentiated thyroid cancer

Therapeutic options for advanced thyroid cancer

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