Differentiated thyroid cancer—personalized therapies to prevent overtreatment

Abstract

The concept of individualized therapy is rapidly gaining recognition in the management of patients with differentiated thyroid cancer (DTC). This Review provides an overview of the most important elements of this paradigm shift in DTC management and discusses the implications for clinical practice. In the majority of patients with DTC who have an inherently good prognosis, the extent of surgery, the dosage of (131)I therapy and the use of levothyroxine therapy are all aspects suitable for individualization, on the basis of both the stage of disease and the response to treatment. In individuals with advanced disease, newer imaging techniques, advances in (131)I therapy and the use of targeted molecular therapies (such as multitargeted kinase inhibitors) have provided new options for the personalized care of patients, for whom until recently no effective therapies were available. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of (131)I treatment, and major salivary gland damage, a common and unpleasant side effect of (131)I therapy. Highly individualized interdisciplinary treatment of patients with DTC might lead to improved outcomes with reduced severity and frequency of complications and adverse effects. However, in spite of ongoing research, personalized therapies remain in their infancy.

First evidence of PSMA expression in differentiated thyroid cancer using [68Ga]PSMA-HBED-CC PET/CT

“…Considering the limited number of therapeutic options currently available for patients with metastasized, 131 I-negative, [ 18 F]-2-fluorodeoxyglucose-positive DTC [5], we hypothesized that PSMA expression could be present in DTC as well. This would provide an interesting new therapeutic option for advanced, 131 I-negative/resistant DTC.…”

Personalized Therapy of Cancer

“…Majority of patients with DTC have a good prognosis. Nevertheless the outcome can be optimized by individualization, of the extent of surgery, the dosage of 131 I therapy and the use of levothyroxine therapy (Luster et al 2014 ). Newer imaging techniques and targeted molecular therapies such as multitargeted kinase inhibitors provide new options for the personalized care of patients with advanced disease for whom no effective therapies were available previously.…”

Nuklearmedizinische Diagnostik, Therapie und Nachsorge des Schilddrüsenkarzinoms

“…Nur unter eindeutig definierten Voraussetzungen kann in der Low-Risk-Gruppe auf eine 131 I-Ganzkörperszintigraphie zur Erfolgskontrolle 6-8 Monate nach einer ablativen 131 I-Therapie verzichtet werden [6]. Unter den Gegebenheiten, dass in einem Endemiegebiet für Schilddrüsenknoten gehäuft mit dem postoperativen Zufallsbefund eines Schilddrüsenkarzinoms zu rechnen ist und dass inkomplette Resektionsverfahren zu einem hohen 131 I-Uptake in der Posttherapieszintigraphie der Ablation führen, wird die Durchführung einer diagnostischen 131 I-Ganzkörperszin-tigraphie 6-8 Monate nach der 131 I-Ablation in Deutschland weiterhin als sinnvoll angesehen.…”