Sorafenib in the treatment of radioiodine-refractory differentiated thyroid cancer: a meta-analysis

Abstract

The advent of biologically targeted agents and increased understanding of thyroid carcinogenesis have generated much interest in the development of biologically targeted therapeutic agents for thyroid cancer. Among them, sorafenib is the most commonly studied drug. The current meta-analysis was carried out to estimate the efficacy and safety of sorafenib administered in radioiodine-refractory differentiated thyroid cancer patients. An electronic search was conducted using PubMed/MEDLINE and EMBASE. Statistical analyses were carried out using either random-effects or fixed-effects models according to heterogeneity. All the statistical analyses were carried out using the Stata version 12.0 software. Seven eligible studies were identified. The final results indicated that 22% of the patients (95% CI: 15-28) achieved a partial response. Hand-foot syndrome, diarrhea, fatigue, rash, weight loss, and hypertension were the most frequently observed adverse effects (AEs) associated with sorafenib use and the incidence of these AEs (all grades) was 80% (95% CI: 68-91), 68% (95% CI: 59-77), 67% (95% CI: 57-78), 66% (95% CI: 50-82), 52%(95% CI: 33-72), and 31% (95% CI: 21-42) respectively. Sixty-two percent (95% CI: 36-89) patients required dose reductions due to toxicity of sorafenib. As far as PR and AEs are concerned, the results of this meta-analysis indicate that sorafenib has a modest effect in patients with radioiodine-refractory differentiated thyroid cancer and the high incidence of AEs associated with this agent may affect the quality of patients' lives. Though the use of sorafenib in the treatment of radioiodinerefractory differentiated thyroid cancer is considered promising by most physicians working in this field, more effective agents with less toxicity and cost are still needed.

Sorafenib treatment of radioiodine-refractory advanced thyroid cancer in daily clinical practice: a cohort study from a single center

“…The results of our study are broadly consistent with previous ones [18,20,21,26,33]. In particular, the disease control rate (PR plus SD for ≥6 months) of our cohort was quite similar to the rate of the DECISION trial (50.0% vs 54.1%, respectively) [27].…”

“…Adverse events were generally consistent with the known safety profile of sorafenib [26,27]. A substantial percentage of our patients discontinued treatment because of side-effects within 3 months.…”

“…This scenario is well known in everyday clinical practice and confirmed by the existing meta-analysis [26,28], but it has been the subject of few reports in the literature.…”

“…New targeted therapies are thus regarded with increasing interest by both endocrinologists and oncologists [29,31]. After the publication of the DECISION trial, sorafenib -the first drug approved for this indication-represents the first-line systemic approach in this setting [26,27]. However, treatment with sorafenib is, at best, effective in stabilizing patients with progressive disease, with a PR rate ranging from 12 to 22% [32].…”

More effective agents still needed for progressive radioiodine-refractory differentiated thyroid cancer

“…A letter (Pitoia 2014) which doubted the conclusions of our meta-analysis (Shen et al 2014) has been published recently, in which the author wondered whether 70% of partial response (PR) plus stabilization of disease (SD) would be considered as a modest response to treatment with sorafenib in patients with radioiodine-refractory differentiated thyroid cancer (DTC). Here, we make some clarifications:…”