Neoadjuvant tyrosine kinase inhibitor therapy in locally advanced differentiated thyroid cancer: a single centre case series

Abstract

Objective Primary surgical resection remains the mainstay of management in locally advanced differentiated thyroid cancer. Tyrosine kinase inhibitors have recently shown promising results in patients with recurrent locally advanced differentiated thyroid cancer. This study discussed four patients with locally advanced differentiated thyroid cancer managed with tyrosine kinase inhibitors used prior to surgery in the ‘neoadjuvant’ setting. Method Prospective data collection through a local thyroid database from February 2016 identified four patients with locally advanced differentiated thyroid cancer unsuitable for primary surgical resection commenced on neoadjuvant tyrosine kinase inhibitor therapy. Results All cases had T4a disease at presentation. Three cases tolerated tyrosine kinase inhibitor therapy for more than 14 months while the last case failed to tolerate treatment at 1 month. All patients subsequently underwent total thyroidectomy to facilitate adjuvant radioactive iodine treatment. Disease-specific survival remains at 100 per cent currently (range, 29–75 months). Conclusion Neoadjuvant tyrosine kinase inhibitors in locally advanced differentiated thyroid cancer can be effective in reducing primary tumour extent to potentially facilitate a more limited surgical resection for local disease control.

Response to sorafenib in a locally advanced oncocytic cell carcinoma of the thyroid

“…However, the cumulative evidence in patients with locally advanced disease is limited, as this subgroup represents the smallest number of cases in pivotal studies of major TKIs 9 10. Based on this evidence, recent studies18–20 propose the neoadjuvant use of TKIs in locally advanced disease to facilitate subsequent successful surgical resection and improved response to radioactive iodine therapy or radiotherapy, as applicable. Yeo et al present a series of cases in which three patients treated with TKIs achieved successful surgical resection following therapy and subsequent radioactive iodine treatment 19.…”

“…Based on this evidence, recent studies18–20 propose the neoadjuvant use of TKIs in locally advanced disease to facilitate subsequent successful surgical resection and improved response to radioactive iodine therapy or radiotherapy, as applicable. Yeo et al present a series of cases in which three patients treated with TKIs achieved successful surgical resection following therapy and subsequent radioactive iodine treatment 19. Huang et al recently published a phase II study using anlotinib as neoadjuvant therapy in locally advanced thyroid cancer, where 13 patients demonstrated an overall response rate of 76% with an acceptable safety profile 20…”

Recurrent Differentiated Thyroid Cancer: The Current Treatment Options

“…for patients who may otherwise be candidates for treatment with tyrosine kinase inhibitors (TKI). TKI has also been used as a neoadjuvant agent prior to salvage surgery [17,[47][48][49].…”