Definition and management of radioactive iodine-refractory differentiated thyroid cancer

Schlumberger, Martin; Brose, Marcia S.; Elisei, Rossella; Leboulleux, Sophie; Luster, Markus; Pitoia, Fabián; Pacini, Furio

doi:10.1016/s2213-8587(13)70215-8

Cited by 291 publications

(192 citation statements)

References 9 publications

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“…These patients represent about one third of all patients with an advanced form of the disease. Partial response and long-term stabilization may be obtained, but cure is rarely achieved in the other two thirds of patients with an advanced form of the disease, who will be classified as refractory at some point during their life (1,6).…”

Section: Defining Rai Refractorinessmentioning

confidence: 99%

“…The probability of obtaining a cure with further RAI treatment is low, and the risk of AEs increases with further treatments (1,5,7). The decision to continue RAI treatment is generally based on the magnitude of tumor response to previous treatment courses, the persistence of a significant RAI uptake, a low 18 FDG uptake in tumor foci, and the absence of detectable side effects (6).…”

Section: Rai Uptake Retained In Some Lesions But Not In Othersmentioning

confidence: 99%

“…Rapidly progressive disease and large tumor burden Large, multiple tumors greater than 1-2 cm in size that are rapidly progressing (within < 12 months) should be considered for treatment; in these patients, treatment should preferably be initiated before the occurrence of symptoms (6,26).…”

Section: When To Initiate An Mki?mentioning

confidence: 99%

“…In contrast, patients with smaller tumors (< 1 cm) or with only a few lesions and with no documented progression rarely require immediate, systemic treatment with an MKI (6).…”

Section: When To Initiate An Mki?mentioning

confidence: 99%

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Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

Schmidt

Iglesias

Klain

et al. 2017

Arch. Endocrinol. Metab.

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Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them. Arch Endocrinol Metab. 2017;61(1):81-9

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Section: Defining Rai Refractorinessmentioning

confidence: 99%

Section: Rai Uptake Retained In Some Lesions But Not In Othersmentioning

confidence: 99%

Section: When To Initiate An Mki?mentioning

confidence: 99%

“…In contrast, patients with smaller tumors (< 1 cm) or with only a few lesions and with no documented progression rarely require immediate, systemic treatment with an MKI (6).…”

Section: When To Initiate An Mki?mentioning

confidence: 99%

See 2 more Smart Citations

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

Schmidt

Iglesias

Klain

et al. 2017

Arch. Endocrinol. Metab.

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“…However, once DTC is no longer amenable to RAI therapy or surgery, expected survival declines rapidly (2-4), and death from thyroid carcinoma within 3 years under these circumstances is common (6)(7)(8). RAI refractory DTC is an advanced cancer that occurs in patients who have at least one tumor focus without radioactive iodine uptake, or by progression of the disease within one year after RAI treatment, and/or in patients with persistent disease after administration of a cumulative radioactivity of 22 GBq (600 mCi) (9). RAI-refractory DTC is rare with an estimated incidence of 4 cases per million population per year (4).…”

Section: Introductionmentioning

confidence: 99%

Partial response to sorafenib treatment associated with transient grade 3 thrombocytopenia in a patient with locally advanced thyroid cancer

Pitoia

Abelleira

Jerkovich

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYAdvanced radioactive refractory and progressive or symptomatic differentiated thyroid carcinoma (DTC) is a rare condition. Sorafenib was recently approved for the treatment of these patients. We present the case of a 67 year old woman diagnosed with DTC who underwent a total thyroidectomy with central, lateral-compartment neck dissection and shaving of the trachea and esophagus due to tumor infiltration. A local recurrence was detected 14 months later requiring, additionally, two tracheal rings resection. The patient received a cumulative 131 I dose of 650 mCi and developed dysphagia and dyspnea 63 months after initial surgery. A 18 FGD-PET/CT showed progression of the local mass associated to hypermetabolic pulmonary nodules. Sorafenib 800 mg/day was then prescribed. A dose reduction to 400 mg/day was necessary due to grade 3 thrombocytopenia that appeared four months after drug prescription. Platelet count went to normal after this dose reduction. Five months after initiation of sorafenib, a partial response of the local mass with significant intra-tumoral necrosis was observed. We conclude that sorafenib is a valid option for locally advanced DTC and that the platelet count should be evaluated regularly because it seems that thrombocytopenia might be more frequently observed in DTC than in other types of tumors. Arch Endocrinol Metab. 2015;59(4):347-50

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Definition and management of radioactive iodine-refractory differentiated thyroid cancer

Cited by 291 publications

References 9 publications

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

Partial response to sorafenib treatment associated with transient grade 3 thrombocytopenia in a patient with locally advanced thyroid cancer

Complete response to larotrectinib treatment in a patient with papillary thyroid cancer harboring an ETV6‐NTRK3 gene fusion

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