Background: Medullary thyroid carcinoma (MTC) accounts for 5% of all thyroid carcinomas. As no effective systemic therapy exists, surgery is the only curative treatment for MTC. In the last few years, several clinical trials have tested the efficacy of new multi-targeted agents such as sorafenib, vandetanib, motesanib, sunitinib and pazopanib in patients with metastatic MTC. Summary:In June 2010, a 38-year-old male patient complained of pain on swallowing and coughs. Physical examination detected a hard nodule of 2 cm on the left side of his neck. A fine-needle aspiration of it yielded evidence of carcinoma. A computed tomography scan showed multiple lyphadenopathies. In August 2010, the patient underwent an incomplete thyroidectomy and received radiotherapy. In spite of that, he was still unable to swallow either solids or liquids, and suffered dyspnoea on moderate exertion. In May 2011, the patient started receiving sorafenib and levothyroxine. After 20 days, his clinical symptoms were less severe and palpable lymphadenopathies shrank by 50%. After 5 months, the patient still had no dysphagia or dyspnoea, but developed fatigue and elevated transaminases. Sorafenib was discontinued and the liver was examined by ultrasonography with no abnormal findings. After a two-week rest period, the patient resumed sorafenib from November 2011 to December 2012, achieving a clinical, biochemical and radiological response. Conclusion:This case provides limited evidence for a potential role for sunitinib in the treatment of patients with metastatic MTC.
Background: The treatment with Trastuzumab (T) is associated with a certain degree of cardiotoxicity. This study sought to evaluate the level of nt-pro-BNP as a possible marker of cardiotoxicity so accurate as the value of left ventricular ejection fraction (LVEF) Patients and methods: Forty patients with breast cancer treated with T were prospectively measured LVFE with echocardiography and nt-pro-BNP level before and every 3 months during T treatment. Median age: 50years(27;70). Received T as adjuvant treatment: 82.5% of the patients and 17.5% for metastatic disease.Patients with previous chemotherapy: 13(32.5%)neoadjuvant, 23(57.5%)adjuvant and 7(17.5%) for metastastic disease. Patients with previous treatment with anthracyclines: 12(30%)neoadjuvant, 21(52.5%)adjuvant and 2(5%)for metastatic disease(one patient had received anthracyclines too during adjuvant treatment).None received anthracyclines and T concomitant. Chi-square analyzed the correlation of high pathological level of nt-pro-BNP (values over the normal ***range, adjusted by the patient age) and a significative decrease of LVEF (more than 10% when LVEF >50% or more than 5% when LVEF< 50%) Results: A decrease in LVEF was observed in 6 patients(15%) and pathological high levels of nt-pro-BNP in 7(17.5%).Two patients(5%) presented cardiac insufficiency with clinical symptoms, in both nt-pro-BNP was higher than 600pg/ml and LVEF lower than 40%. In the other patients the decreases of LVEF(never were<40%) or high levels of nt-proBNP(never were>600pg/ml)were not related to any clinical symptoms. Chi-square analysis showed a correlation between pathological high levels of nt-pro-BNP and significative decrease of LVEF (p=0.001), The estimated risk of a false negative nt-pro-BNP result (nt-pro-BNP normal value and significative LVEF decrease) was 2.735% (95 % confidence interval: 0.878 to 8.522 %) and the estimated risk of a false positive nt-pro-BNP result (nt-pro-BNP pathological value and no significative LVEF decrease) was 0.132%(95% confidence interval: 0.39 to 0.448%) Conclusion:The level of nt-pro-BNP is a possible marker of cardiotoxicity so accurate as the value of LVEF in patients with breast cancer treated with T. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-20-02.
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