Real-World Efficacy and Safety of Cabozantinib and Vandetanib in Advanced Medullary Thyroid Cancer

Koehler, Viktoria Florentine; Adam, Pia; Frank‐Raue, Karin; Raue, Friedhelm; Berg, Elke; Hoster, Eva; Allelein, Stephanie; Schott, M.; Kroiß, Matthias; Spitzweg, Christine

doi:10.1089/thy.2020.0206

Cited by 47 publications

(46 citation statements)

References 27 publications

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“…Several recent real-world multicenter studies and meta-analysis also showed that vandetanib and cabozantinib had significant clinical benefits for objective response rate (ORR) and PFS in advanced MTC [23][24][25][26]. We demonstrated that median PFS from the start of vandetanib was 25.9 months, but the median OS was not reached [23].…”

Section: Management In Persistent or Recurrent Mtcmentioning

confidence: 72%

“…We demonstrated that median PFS from the start of vandetanib was 25.9 months, but the median OS was not reached [ 23 ]. In addition, German real world multicenter study recently reported that the median OS from the initiation of vandetanib therapy was 53 months (95% CI, 43.7 to 62.3) and 24 months (95% CI, 5.9 to 42.1) for cabozantinib [ 24 ].…”

Section: Management In Persistent or Recurrent Mtcmentioning

confidence: 99%

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Current Guidelines for Management of Medullary Thyroid Carcinoma

Kim

2021

Endocrinol Metab

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Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from the parafollicular cells. The diagnostic and therapeutic strategies for the condition are different from those used for well-differentiated thyroid cancer. Since the 2015 American Thyroid Association guidelines for the diagnosis and treatment of MTC, the latest, including the National Comprehensive Cancer Network and European Association for Medical Oncology guidelines have been updated to reflect several recent advances in the management of MTC. Advances in molecular diagnosis and postoperative risk stratification systems have led to individualized treatment and follow-up strategies. Multi-kinase inhibitors, such as vandetanib and cabozantinib, can prolong disease progression-free survival with favorable adverse effects. In addition, potent selective rearranged during transfection (RET) inhibitors (selpercatinib and pralsetinib) have shown a promising efficacy in recent clinical trials. This review summarizes the management of MTC in recent guidelines focused on sporadic MTC.

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Section: Management In Persistent or Recurrent Mtcmentioning

confidence: 72%

Section: Management In Persistent or Recurrent Mtcmentioning

confidence: 99%

Current Guidelines for Management of Medullary Thyroid Carcinoma

Kim

2021

Endocrinol Metab

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“…This is underlined by real-world data reporting that only 14% of patients were started at the planned dose of 140 mg cabozantinib. 18 If aiming for full dosing according to pivotal studies and objective response, we tend to start treatment with vandetanib; however, there are also patients where cabozantinib might be preferred, especially in view of long-QT interactions, which are frequent with vandetanib. A further unanswered question is the benefit of sequential treatment with both TKIs upon progression following one substance.…”

Section: Managment Of Advanced Mtc—systemic Therapymentioning

confidence: 99%

How I treat medullary thyroid cancer

et al. 2021

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Medullary thyroid cancer (MTC) represents a rare neuroendocrine neoplasm originating from neoplastic C-cells in the thyroid gland. While localized disease is potentially curable with an optimized surgical approach, the number of relapses is high, and a considerable number of patients present with primary metastatic disease. Multidisciplinary management including standardized surveillance following surgery, but also early involvement of medical oncologists, is therefore important. Several oncogenic pathways are involved in the pathogenesis of MTC including vascular endothelial growth factor receptor, epidermal growth factor receptor, MET, and most importantly RET, and the multi-tyrosine kinase inhibitors vandetanib and cabozantinib have been approved for advanced MTC based on data from phase III studies. As activating RET mutations represent the most important driver, specific RET inhibitors were introduced and suggest high response rates with limited off-target toxicities. The current review provides a practical overview on clinical presentation and management from early to advanced MTC.

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“…Target therapies, including multikinase inhibitors and mammalian target of rapamycin inhibitors, have a role in treating advanced thyroid cancers [95][96][97][98][99][100]. Some kinase inhibitors, including sorafenib, sunitinib, and vandetanib, were used against other viral agents, including coronaviruses, and their efficacy as therapeutic instruments in COVID-19 are currently under investigation [101].…”

Section: Could Medical Management Of Thyroid Diseases Influence the Clinical Course Of Covid-19?mentioning

confidence: 99%

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

Lisco

Tullio

Jirillo

et al. 2021

J Endocrinol Invest

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Background Thyroid dysfunction has been observed in patients with COVID-19, and endocrinologists are requested to understand this clinical issue. Pandemic-related restrictions and reorganization of healthcare services may affect thyroid disease management. Objective and methods To analyze and discuss the relationship between COVID-19 and thyroid diseases from several perspectives. PubMed/MEDLINE, Google Scholar, Scopus, ClinicalTrial.gov were searched for this purpose by using free text words and medical subject headings as follows: “sars cov 2”, “covid 19”, “subacute thyroiditis”, “atypical thyroiditis”, “chronic thyroiditis”, “hashimoto’s thyroiditis”, “graves’ disease”, “thyroid nodule”, “differentiated thyroid cancer”, “medullary thyroid cancer”, “methimazole”, “levothyroxine”, “multikinase inhibitor”, “remdesivir”, “tocilizumab”. Data were collected, analyzed, and discussed to answer the following clinical questions: “What evidence suggests that COVID-19 may induce detrimental consequences on thyroid function?"; "Could previous or concomitant thyroid diseases deteriorate the prognosis of COVID-19 once the infection has occurred?”; “Could medical management of thyroid diseases influence the clinical course of COVID-19?”; “Does medical management of COVID-19 interfere with thyroid function?”; “Are there defined strategies to better manage endocrine diseases despite restrictive measures and in-hospital and ambulatory activities reorganizations?”. Results SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. Patients with baseline thyroid diseases are not at higher risk of contracting or transmitting SARS-CoV-2, and baseline thyroid dysfunction does not foster a worse progression of COVID-19. However, it is unclear whether low levels of free triiodothyronine, observed in seriously ill patients with COVID-19, may worsen the disease's clinical progression and, consequently, if triiodothyronine supplementation could be a tool for reducing this burden. Glucocorticoids and heparin may affect thyroid hormone secretion and measurement, respectively, leading to possible misdiagnosis of thyroid dysfunction in severe cases of COVID-19. High-risk thyroid nodules require a fine-needle aspiration without relevant delay, whereas other non-urgent diagnostic procedures and therapeutic interventions should be postponed. Discussion Currently, we know that SARS-CoV-2 could lead to short-term and reversible thyroid dysfunction, but thyroid diseases seem not to affect the progression of COVID-19. Adequate management of patients with thyroid diseases remains essential during the pandemic, but it could be compromised because of healthcare service restrictions. Endocrine care centers should continuously recognize and classify priority cases for in-person visits and therapeutic procedures. Telemedicine may be a useful tool for managing patients not requiring in-person visits.

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Real-World Efficacy and Safety of Cabozantinib and Vandetanib in Advanced Medullary Thyroid Cancer

Cited by 47 publications

References 27 publications

Current Guidelines for Management of Medullary Thyroid Carcinoma

Current Guidelines for Management of Medullary Thyroid Carcinoma

How I treat medullary thyroid cancer

Thyroid and COVID-19: a review on pathophysiological, clinical and organizational aspects

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