The Noninvestigational Use of Tyrosine Kinase Inhibitors in Thyroid Cancer: Establishing a Standard for Patient Safety and Monitoring

Abstract

Review of available published data and the collective experience prescribing tyrosine kinase inhibitors at The University of Texas MD Anderson Cancer Center have highlighted the need for a systematic, comprehensive, and uniform approach to managing these patients. This paper discusses the approach adopted by the Department of Endocrine Neoplasia at the MD Anderson Cancer Center and illustrates practice patterns, experience, and our standardized approach related to prescribing commercially available tyrosine kinase inhibitors outside of the context of a clinical trial for patients with advanced thyroid cancer.

THERAPY OF ENDOCRINE DISEASE: Treatment of malignant pheochromocytoma and paraganglioma

“…Some medications, such as opioids and vincristine, may exacerbate these symptoms. Gastrointestinal bleeding and perforation have also been described in patients treated with tyrosine kinase inhibitors (27). Treatment for constipation may include oral fiber supplements, osmotic agents (e.g., lactulose and polyethylene glycol), lubricants and emollients (e.g., mineral oil and docusate), gastrointestinal stimulants (e.g., bisacodyl), a-blockers, a-methyl-para-tyrosine, and/or enemas (28).…”

Sorafenib treatment of radioiodine-refractory advanced thyroid cancer in daily clinical practice: a cohort study from a single center

“…This scenario is well known in everyday clinical practice and confirmed by the existing meta-analysis [26,28], but it has been the subject of few reports in the literature.…”

“…Dose adjustments of L-thyroxine due to change in TSH levels were rather common in our cohort. Indeed, TSH levels should be monitored frequently during treatment with sorafenib, adjusting L-thyroxine dose accordingly [28].…”

“…Actually, treatment with sorafenib present difficulties in daily clinical practice. Thus, a detailed discussion and obtaining written informed consent from the patient before initiation of TKI therapy are fundamental aspects [28].…”

“…The drug dose was sequentially reduced or interrupted in case of important side effects, according to previous recommendations [28]. Treatment continued until disease progression or unacceptable toxicity.…”