Medical management of metastatic medullary thyroid cancer

Abstract

Medullary thyroid cancer (MTC) is an aggressive form of thyroid cancer, which occurs in both heritable and sporadic forms. Discovery that mutations in the RET protooncogene predispose to familial cases of this disease has allowed for presymptomatic identification of gene carriers and prophylactic surgery to improve the prognosis of these patients. A significant number of patients with the sporadic type of MTC and even with familial disease, still present with nodal or distant metastases, making surgical cure difficult. Over the past several decades, many different types of therapy for metastatic disease have been attempted, with limited success. Improved understanding of the molecular defects and pathways involved in both familial and sporadic MTC has resulted in new hope for these patients with the development of drugs targeting the specific alterations responsible. This new era of targeted therapy with kinase inhibitors represents a significant step forward from previous trials of chemotherapy, radiotherapy, and hormonal therapy. Although much progress has been made, additional agents and strategies are needed to achieve durable, long-term responses in patients with metastatic MTC. This article reviews the history and results of medical management for metastatic MTC from the early 1970s up until the present day.

Sorafenib in the treatment of thyroid cancer

“…MTC is a slow-growing cancer, and even the 10-year overall survival rate is 40-50% in the presence of metastatic disease. Surgery is the only curative modality available [39], and no effective therapies exist for metastatic MTC, as it is not responsive to external radiotherapy, radionuclide therapy or chemotherapy.…”

Four Difficult Thyroid Cancer Cases: Incorporating Medical Therapies

“…There is a tendency to spread quickly to locoregional lymph nodes at presentation that makes early definitive surgery P a g e | 24 difficult. A total thyroidectomy and lymphadenectomy will result in biochemical remission and cure in 40% of cases 21 . MTC is derived from the C cells of the thyroid follicle, which represents a variant of a neuroendocrine cell that produces calcitonin and does not concentrate iodine.…”

Therapeutic effects of adenovirus‑mediated CD and NIS expression combined with Na131I/5‑FC on human thyroid cancer

“…A previous study indicated that the thyroid cancer incidence rate in Canada was the fastest increasing rate in the world, t trends in the incidence rate of thyroid cancer have demonstrated a 6.8% increase for males and 6.9% increase for females per annum between 1998 and 2007 (16)(17)(18). Most recently, the number of new cases of thyroid cancer is estimated to be 12.9 per 100,000 men and women annually in 2015 in the US (19,20).…”

“…At present, previous studies (17,19,21) have suggested that gene therapy is the most promising and effective therapeutic method for thyroid cancer. The principle of gene therapy depends on the intracellular conversion of a relatively non-toxic pro-drug (or drug gene) to a toxic drug (therapeutic protein) through gene transcription and translation processes.…”

“…The principle of gene therapy depends on the intracellular conversion of a relatively non-toxic pro-drug (or drug gene) to a toxic drug (therapeutic protein) through gene transcription and translation processes. The gene therapy method exhibits more advantages than conventional chemotherapy, as it limits the pro-drug-induced toxicity to the targeted cells (17,19,(21)(22)(23). The surrounding cells and tissues are not affected by systemic toxicity.…”