Clinical Efficacy of Targeted Biologic Agents as Second-Line Therapy of Advanced Thyroid Cancer

Owonikoko, Taofeek K.; Chowdry, Rajasree Pia; Kim, Sungjin; Saba, Nabil F.; Shin, Dong M.; Khuri, Fadlo R.

doi:10.1634/theoncologist.2013-0250

Cited by 12 publications

(16 citation statements)

References 30 publications

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“…If widespread disease progression continues despite treatment, transition to a second-line agent should be considered. Consideration should be given for second-line targeted therapy following first-line treatment failure based on reports of possible incremental benefit and minimal cross-resistance between agents despite their similar mechanisms of action [27,38,42–45,50,56,97]. However, there is a paucity of robust data to guide choice of agent or to conclusively support improved outcomes with second-line therapy in most thyroid cancers, and it is therefore recommended that eligibility for enrollment in available clinical trials be investigated in these circumstances [3,6,8].…”

Section: Adopting Tkis Into Treatment Algorithms For Thyroid Cancermentioning

confidence: 99%

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Lirov

Worden

Cohen

2017

Drugs

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Until recently, patients with advanced thyroid cancers had limited options for systemic treatment. With the introduction of tyrosine kinase inhibitors (TKIs) as a promising new class of targeted therapies for thyroid cancer, suddenly patients with advanced disease were given new options to extend survival. Guidelines worldwide have been updated to include general indications for these newer agents, but questions remain regarding which agent(s) to select, when to begin treatment, and how long therapy should continue. Additionally, the true impact of TKIs on overall survival and quality-of-life in thyroid cancer patients needs further clarification. As familiarity with approved agents and longer-term data become available, better strategies for implementation of these targeted drugs will evolve to optimize benefit for patients living with metastatic disease.

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Section: Adopting Tkis Into Treatment Algorithms For Thyroid Cancermentioning

confidence: 99%

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Lirov

Worden

Cohen

2017

Drugs

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“…25 If patients need to discontinue sorafenib because they have severe side ef-fects, do not experience response to sorafenib, or experience progression on sorafenib, then other commercially available small molecule kinase inhibitors may also be considered, including pazopanib, sunitinib, vandetanib, or axitinib, although none have been approved by the FDA for differentiated thyroid cancer (see PAP-9, page 1675). [55][56][57] For the 2014 update, vandetanib and axitinib were added to the footnote as additional recommended kinase inhibitors that may also be considered based on results from recent phase II trials. [34][35][36] In addition, pazopanib was changed from a category 2B recommendation to a category 2A recommendation based on results of a phase II trial and on panel experience.…”

Section: Kinase Inhibitorsmentioning

confidence: 99%

Thyroid Carcinoma, Version 2.2014

Tuttle¹,

Haddad²,

Ball³

et al. 2014

J Natl Compr Canc Netw

150

105

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These NCCN Guidelines Insights focus on some of the major updates to the 2014 NCCN Guidelines for Thyroid Carcinoma. Kinase inhibitor therapy may be used to treat thyroid carcinoma that is symptomatic and/or progressive and not amenable to treatment with radioactive iodine. Sorafenib may be considered for select patients with metastatic differentiated thyroid carcinoma, whereas vandetanib or cabozantinib may be recommended for select patients with metastatic medullary thyroid carcinoma. Other kinase inhibitors may be considered for select patients with either type of thyroid carcinoma. A new section on "Principles of Kinase Inhibitor Therapy in Advanced Thyroid Cancer" was added to the NCCN Guidelines to assist with using these novel targeted agents.

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“…These clinical data are supported by preclinical studies that validate mTOR signaling as potential target in MTC [41, 42]. However, as the efficacy of single-agent everolimus in MTC has been limited and may result in even less clinical benefit in the second-line setting [43], mTOR inhibitors may be most useful in targeted therapy combinations to overcome resistance to RET targeting. A case report describes systemic activity of vandetanib plus everolimus against RET -rearranged lung cancer [44].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Genomic Profiling of Clinically Advanced Medullary Thyroid Carcinoma

Heilmann¹,

Subbiah

Wang³

et al. 2016

Oncology

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Objective: The aim of this study was to determine the genomic alterations of cancer-related genes in advanced medullary thyroid carcinoma during the course of clinical care. Methods: Hybrid-capture-based comprehensive genomic profiling was performed on 34 consecutive medullary thyroid carcinoma cases to identify all four classes of genomic alterations, and outcome for an index patient was collected. Results:RET was mutated in 88% (30/34) of cases, with RET M918T being responsible for 70% (21/30) of the RET alterations. The other RET alterations were RET E632_L633del, C634R, C620R, C618G/R/S, V804M, and RET amplification. Two of the four RET wild-type patients harbored mutations in KRAS or HRAS (1/34 each). The next most frequent genomic alterations were amplifications of CCND1, FGF3, and FGF19 and alterations in CDKN2A (3/34 each). One case with a RET M918T mutation developed acquired resistance to progressively dose-escalated vandetanib. When the mTOR inhibitor everolimus was added to continued vandetanib treatment, the patient achieved a second 25% reduction of tumor volume (RECIST 1.1) for 8 months. Conclusions: Comprehensive genomic profiling identified the full breadth of RET alterations in metastatic medullary thyroid carcinoma and possible cooperating oncogenic driver alterations. This approach may refine the use of targeted therapy for these patients.

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Clinical Efficacy of Targeted Biologic Agents as Second-Line Therapy of Advanced Thyroid Cancer

Abstract: Learning Objectives List the therapeutic opportunities with tyrosine kinase inhibitors for advanced thyroid cancer, especially in the frontline setting. Describe and discuss the current knowledge and experience with salvage therapy with biologic agents for thyroid cancer.

Cited by 12 publications

References 30 publications

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Thyroid Carcinoma, Version 2.2014

Comprehensive Genomic Profiling of Clinically Advanced Medullary Thyroid Carcinoma

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