Notable Decrease of Malignant Pleural Effusion After Treatment with Sorafenib in Radioiodine-Refractory Follicular Thyroid Carcinoma

Liu, Min; Shen, Yan; Ruan, Min; Li, Minghua; Chen, Libo

doi:10.1089/thy.2013.0703

Cited by 15 publications

(7 citation statements)

References 24 publications

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“…It was noteworthy that a high incidence of AEs and drug interruption had been observed in two phase II studies subsequently . Later, Waguespack et al described a dramatic improvement in an adolescent with progressive RR‐DTC who was treated with sorafenib using 200 mg twice daily , which has been previously demonstrated as a feasible approach with comparable efficacy by our team . In the present study, lower incidences and less severity of AEs were certified by comparing with high‐dose strategy (400 mg twice daily) with grade 3–4 HFS (1.4% vs. 7%–44%), diarrhea (2.8% vs. 6%–15%), weight loss (0% vs. 10%), fatigue (0% vs. 9%–16%), and hypertension (6.9% vs. 6%–16%) .…”

Section: Discussionsupporting

confidence: 56%

“…The objective of this study was to determine the predictive significance of clinicopathological features on outcomes in patients with RR‐DTC treated with sorafenib. As previously reported by our group, sorafenib was initially administered at a dose of 200 mg orally twice a day until it was discontinued because of disease progression, uncontrollable side effects, or death or at the patient's request . Screening evaluations, including medical history, demography, review of prior treatment, physical examination, baseline imaging, and laboratory evaluations, were completed within 1 week before the start of sorafenib administration.…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

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Clinicopathological Features Predict Outcomes in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer Treated with Sorafenib: A Real-World Study

Cheng

Jin

et al. 2020

The Oncologist

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Background. Because beneficial response and progression-free survival (PFS) were achieved by well-designed clinical trials with tyrosine kinase inhibitors (TKIs) in patients with progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC), the overall survival (OS) and improvement of therapeutic outcomes in the real world have been anticipated. Subjects, Materials, and Methods. This prospective, singlecenter, real-world study assessed the predictive significance of clinicopathological features on disease control rate (DCR), objective response rate (ORR), PFS, and OS in a cohort of 72 patients with progressive RR-DTC treated with sorafenib at an initial dose of 200 mg twice daily. Results. Disease control, objective response, and biochemical effectiveness were achieved in 73.3%, 21.7%, and 77.9% of patients, respectively. The median PFS and OS were 17.6 and 28.9 months, respectively. Multivariate analyses showed that hand-foot syndrome (HFS) was an independent predictor for better DCR and ORR, and 131 I-avidity for higher ORR. In univariate analyses, longer PFS and OS were observed in patients with Eastern Cooperative Oncology Group performance status (ECOG PS) ≤2, pathologically well DTC, lung-only metastasis, absence of bone metastasis, biochemically nonineffective response, HFS, or radiological disease control. In multivariate analyses, only well DTC and ECOG PS ≤2 remained as independent prognostic factors for more favorable PFS and OS, respectively, whereas the absence of bone metastasis and biochemically nonineffective response independently predicted superior PFS and OS.Conclusion. This study demonstrated that clinicopathological features might play a vital role in predicting therapeutic outcomes in patients with progressive RR-DTC treated with sorafenib, warranting further optimization of candidates for TKIs. The Oncologist 2020;25:e668-e678 Implications for Practice: This prospective, single-center, real-world study was designed to investigate the significance of clinicopathological features in predicting response, progression-free survival, and overall survival in patients with progressive radioiodine-refractory differentiated thyroid cancer (DTC) treated with sorafenib. Multivariate analyses showed that hand-foot syndrome was an independent predictor for better response. Meanwhile, well DTC, Eastern Cooperative Oncology Group performance status ≤2, biochemically nonineffective response, and the absence of bone metastasis were independent prognostic factors for more favorable survival. This study demonstrated that clinicopathological features might play a vital role in predicting outcomes in sorafenib-treated patients with radioiodine-refractory DTC, warranting optimization of indications.

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Section: Discussionsupporting

confidence: 56%

Section: Subjects Materials and Methodsmentioning

confidence: 99%

Clinicopathological Features Predict Outcomes in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer Treated with Sorafenib: A Real-World Study

Cheng

Jin

et al. 2020

The Oncologist

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“…This endeavor may pave a way to new adjuvant therapy for surgery, which has been previously reported in RR-DTC by our team 9. Hypertension, hand-foot syndrome, dental ulcer, fatigue, and decreased appetite were observed, which are known classical side effects of VEGFR-targeted treatments,17 which were lightened with supportive treatment and dose reductions as reported by our group and others 24,25. Pneumonia and respiratory failure beyond of known Apatinib-induced adverse events were considered as the causes of death instead of complications related to the treatment, which may be further explained by decreased cough reflex associated with severely aging, difficulty of expectoration due to tracheal stenosis, and the absence of objective disease progression 17,26…”

Section: Discussionsupporting

confidence: 65%

<p>Initial Therapy of Advanced Anaplastic Thyroid Cancer via Targeting VEGFR-2: A Case Report</p>

Cheng

Jiao

Jin

et al. 2019

OTT

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Preclinical studies have demonstrated that Apatinib, major targeting vascular endothelial growth factor receptor-2 (VEGFR-2), could inhibit the proliferation of anaplastic thyroid carcinoma (ATC) cells in vitro and in vivo. The efficacy and safety in ATC patients, however, remains unknown. Here, we report the case of a 93-year-old female with advanced ATC who initially treated with Apatinib. The tumor shrank notably 4 weeks after the initiation of therapy, which sustained for more than 30 weeks. The cervical CT illuminated a stable disease with a best response of 19.7% of the primary lesion and shrinkage of the metastatic lymph node. Adverse events, including hypertension, dental ulcer, hand-foot syndrome, fatigue, and anorexia, were observed and lightened with supportive treatment and dose reductions. The overall survival of the patient was 41 weeks. This is the first report describing the effectiveness of the VEGFR-2 inhibitor for the treatment of advanced ATC, warranting clinical trials to further ascertain its utility in this challenging setting.

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“…In 2014 and 2015, it was reported that the tyrosine kinase inhibitor sorafenib and the multikinase inhibitor lenvatinib increase progression-free survival in patients with RAI-refractory metastatic thyroid carcinoma (27,28). Since that time, there has been a case report demonstrating a notable decrease in a malignant pleural effusion after treatment with sorafenib in RAI-refractory follicular thyroid carcinoma (29) and a subsequent report of rapid pleural effusion accumulation after discontinuation of lenvatinib (30). This is important to note, as it seems that currently available therapeutic options have the potential to improve the prognostic outcomes of patients who have metastatic thyroid carcinoma, that is, radioiodine refractory, in addition to help resolve and prevent the re-accumulation of pleural effusion in these patients.…”

Section: Discussionmentioning

confidence: 99%

Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma

Broome

Gadre

Fayazzadeh

et al. 2020

Endocrine Connections

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Objective: To identify novel prognostic risk factors and compare them with other known prognostic risk factors in follicular cell derived thyroid carcinoma (FDTC) with distant metastases. Methods: A retrospective review was conducted of adult patients with metastatic FDTC seen at a tertiary care center between January 1990 and December 2010. A 15-year Kaplan-Meier survival estimate was created for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) and P values from Cox proportional hazard models were used with a 95% confidence interval (CI). Results: There were 143 patients (60.1% male, 39.9% female), of whom 104 (72.7%) patients had papillary, 30 (21.0%) had follicular, 5 (3.5%) had poorly differentiated, and 4 (2.8%) had Hürthle cell cancers. Median length of follow-up was 80.0 months (range 1.0-564.0). The 15-year mortality rate was 32.2% and cancer-specific mortality was 25.2%, with OS and CSS having the same risk factors. Lung was the most common site of metastases in 53 patients (37.1%), and patients with pleural effusions had significantly lower CSS (HR = 5.21, CI = 1.79-15.12). Additional risk factors for a decreased CSS included: older age upon diagnosis (>45 years, HR = 4.15, CI = 1.43-12.02), multiple metastatic locations (HR = 3.75, CI = 1.32-10.67), and incomplete/unknown tumor resection (HR = 2.35, CI = 1.18-4.67). Conclusion: This study is the first to demonstrate that pleural effusion is a poor prognostic sign in patients with FDTC with distant metastases and compare this risk with other accepted prognostic variables.

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Notable Decrease of Malignant Pleural Effusion After Treatment with Sorafenib in Radioiodine-Refractory Follicular Thyroid Carcinoma

Abstract: As a grim prognostic indicator for patients with DTC, no standard treatment recommendation for pleural effusion exists. Targeted therapy using sorafenib may be an effective therapeutic strategy in the treatment of MPE caused by FTC.

Cited by 15 publications

References 24 publications

Clinicopathological Features Predict Outcomes in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer Treated with Sorafenib: A Real-World Study

Clinicopathological Features Predict Outcomes in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer Treated with Sorafenib: A Real-World Study

<p>Initial Therapy of Advanced Anaplastic Thyroid Cancer via Targeting VEGFR-2: A Case Report</p>

Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma

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