Standard and Emerging Therapies for Metastatic Differentiated Thyroid Cancer

Abstract

After completing this course, the reader will be able to:1. Describe the role and limitations of traditional treatments for metastatic differentiated thyroid cancer.2. Discuss the molecular basis of and clinical evidence for novel and emerging treatments for metastatic differentiated thyroid cancer.3. Identify suitable candidates for clinical trials among your patients with radioactive iodine refractory, metastatic differentiated thyroid cancer and enroll them.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTDifferentiated thyroid cancer accounts for >90% of cases of thyroid cancer, with most patients having an excellent prognosis. Distant metastases occur in 10%-15% of patients, decreasing the overall 10-year survival rate in this group to 40%. Radioactive iodine has been the mainstay of treatment for distant metastases, with good results when lesions retain the ability to take up iodine. For patients with metastatic disease resistant to radioactive iodine, treatment options are few and survival is poor. Chemotherapy and external beam radiotherapy have been used in these patients, but with disappointing results. In recent years, our understanding of the molecular pathways involved in thyroid cancer has increased and a number of molecular targets have been identified. These targets include the protooncogenes BRAF and RET, known to be common mutations in thyroid cancer; vascular endothelial growth factor receptor and platelet-derived growth factor receptor, associated with angiogenesis; and the sodiumiodide symporter, with the aim of restoring its The Oncologist CME Program is located online at http://cme.theoncologist.com/.To take the CME activity related to this article, you must be a registered user. EndocrinologyThe

Clinical experience in using lenvatinib in patients with progressive, radioactive iodine-refractory differentiated thyroid cancer

“…Отдаленные метастазы при первичной диагностике обнаруживают менее чем в 5 % случаев. Однако рецидив заболевания возникает у 10-15 % пациентов, из них у 66 % -в первые 10 лет после первичной терапии [1]. Метастатический ДРЩЖ, который становится неопе-рабельным или резистентным к терапии РАЙ, характе-ризуется низкими показателями выживаемости.…”

When Thyroid Carcinoma Goes Bad: A Morphological and Molecular Analysis

“…Most carcinomas derived from the follicular epithelium of the thyroid gland are well differentiated ([90 %) and wellbehaved, with a 10-year disease-specific survival of 85-92 % [1,2]. These indolent cancers are localized to the thyroid gland, do not recur or metastasize beyond local lymph nodes, and are thus easily curable with hemi-or total thyroidectomy, with possible local nodal dissection and/or radioactive iodine ablation.…”

“…Distant metastasis develops in only 1-15 % of thyroid carcinomas, but when it occurs, it decreases the 10-year survival to 10-40 % [2,3]. The latest data from Cancer Care Ontario has shown that distant metastasis occurs in \1 % of thyroid cancer patients [3].…”

“…For instance, a well-differentiated thyroid carcinoma without capsular or vascular invasion, whether PTC or follicular thyroid carcinoma (FTC), is an indolent entity, with a 5 year survival of over 95 % [6]. The presence of local invasion and/or lymph node metastasis portends a higher risk of local recurrence, but perhaps because of the availability of highly effective targeted radioactive iodine therapy, long-term outcomes remain favorable [1,2]. In contrast, the widely invasive FTC with angioinvasion is untreatable and the 5 year survival is dismal at 38 % [6].…”

The use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in patients with differentiated thyroid cancer after initial treatment

“…Место совмещенной позитронно-эмиссионной и компьютерной томографии с 18-фтордезоксиглюкозой в диагностике отдаленных метастазов дифференцированного рака щитовидной железы У 10-15 % больных с ДРЩЖ встречаются от-даленные метастазы, снижающие общую 10-летнюю выживаемость в этой группе до 40 % [17]. Легкие являются самой частой мишенью отдаленного мета-стазирования, составляя 50 % от всех очагов, ко-сти -25 %, сочетание метастазов в легких и костях встречается в 20 % случаев, метастазы в другие ор-ганы -в 5 % [18].…”