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Metastatik tiroid kanserinde sistemik tedavi etkinliğinin retrospektif olarak değerlendirilmesi

Year 2019, Volume: 32 Issue: 1, 33 - 37, 29.01.2019
https://doi.org/10.5472/marumj.518826

Abstract

Amaç: Tiroid kanserleri, endokrin kanserleri içerisinde en
sık görülen kanserdir. Metastatik tiroid kanserlerinin sistemik
tedavisinde güncel yaklaşımlar faz II çalışması olan kemoterapi
ve faz III çalışması tirozin kinaz inhibitörleridir. Çalışmamızda,
metastatic tiroid kanserli hastalarda sistemik tedavilerin etkinliğini
belirlemeyi hedefledik.
Gereçler ve Yöntemler : Maslak Acıbadem Hastanesi Tıbbi
Onkoloji Kliniği’ne 2008 ile 2015 yılları arasında ve 2016 ile 2018
yılları arasında Sağlık Bakanlığı Sağlık Bilimleri Üniversitesi
Ümraniye Eğitim ve Araştırma Hastanesi Tıbbi Onkoloji
Kliniği’ne gelen ,hem metastaz gelişmesi, hem de radyoaktif iyot
tedavisine refrakter olması nedeniyle sistemik tedavi amacıyla
yönlendirilmiş olan 57 metastatik tiroid kanseri olan hastaların
dosyaları retrospektif olarak analiz edildi.
Bulgular : Hastaların, %52’si (30 hasta) kadın, %48’i (27
hasta) erkek, yaş ortalaması 57,11, ve tamamı 18 yaşın üzerinde
idi. Hastaların, %59,8’i (35 hasta) iyi diferansiye tiroid kanseri,
%29,8’i (17 hasta) medüller tiroid kanseri, %5,3’ü (3 hasta)
anaplastik tiroid kanseri, % 3,5’i ( 2 hasta) az diferansiye kanseri
ve %1,8’i ( 1 hasta) medüller-papiller senkron kanseri idi. Birinci
seri sistemik tedavi yanıtı tüm 57 olguda değerlendirildiğinde
progresyonsuz sağ kalım (PFS) süresi kemoterapi ve sorafenib için
sırasıyla 4,25 ve 6,33 ay olarak tespit edildi (P:0.035). İkinci seride
toplam 57 hasta dosyası retrospektif olarak değerlendirildi ve PFS,
kemoterapi alan ve sorafenib kullanılan hastalarda 4,1 ve 7,77 ay
olarak bulundu (P<0.001).
Sonuç: Radyoaktif iyot tedavisine refrakter olarak diferansiye
tiroid kanserleri ve medüller tiroid kanserleri tedavisinde tirozin
kinaz inhibitörü kullanılmaktadır. Tiroid kanserlerinde lenvatinib,
sorafenib ve vandetanibin progresyonsuz sağkalım üzerine olan
etkisi sistemik kemoterapiden üstün bulunmuştur. Özellikle,
ülkemizde olmak üzere radyoaktif iyod tedavisine refrakter iyi
diferansiye tiroid kanserlerinde sorafenib, etkinlik ve toksisite
profili açısından tercih edilebilecek bir sistemik tedavi seçeneğidir.

References

  • 1. Shah JP. Thyroid carcinoma: Epidemiology, histology, and diagnosis. Clin Adv Hematol Oncol 2015; 13(4 Suppl 4): 3-6.
  • 2. Brown RL, De Souza JA, Cohen EE. Thyroid cancer: Burden of illness and management of disease. J Cancer 2011;2:193- 199. doi: https://doi.org/10.1530/ERC-16-0372.
  • 3. Pacini F, Castagna MG, Brilli L, Pentheroudakis G. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23 (suppl 1): vii110–9. doi.org/10.1093/annonc/mds230.
  • 4. Barut F. Tiroid kanserlerinin patolojisi. Turkiye Klinikleri J Med Oncol-Special Topics 2017;10:10-2.
  • 5. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 ;19:1167-214. doi: 10.1089/ thy.2009.0110.
  • 6. Albero A, Lopéz JE, Torres A, et al. Effectiveness of chemotherapy in advanced differentiated thyroid cancer: a systematic review. Endoc Relat Cancer 2016;23:R71-84. doi: 10.1530/ERC-15-0194.
  • 7. Kormaz T, Er Ö. Tiroid kanserlerinde tirozin kinaz inhibitör tedavisi, kemoterapi ve gelecekteki olası tedaviler. Turkiye Klinikleri J Med Oncol-Special Topics 2017;10:50-5.
  • 8. Baran A., Yılmaz M. Tiroid kanserlerinde kemoterapi ve hedefe yönelik tedaviler. Türkiye Kanserle Savaş Vakfı Kanser Gündemi Tiroid Kanseri 2015;3/3:62-4.
  • 9. Gottlieb JA, Hill CS Jr. Chemotherapy of thyroid cancer with adriamycin. Experience with 30 patients. N Eng Med J 1974;290:193-7. doi:10.1056 /NEJM 197.401.242900404
  • 10. Shimaoka K, Schoenfeld DA, DeWys WD, et al. A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 1985;56:2155-60. doi: 10.1002/1097- 0142(19851101)56:9<2155.
  • 11. Matuszczyk A, Petersenn S, Voigt W, et al. Chemotherapy with paclitaxel and gemcitabine in progressive medullary and thyroid carcinoma of the follicular epithelium. Horm Metab Res 2010;42:61-4. doi: 10.1055/s-0029.123.8294.
  • 12. Abramson V, Troxel AB, Nellore A, et al. Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol 2008;26:4714-9. doi: 10.1200/JCO.2008.16.3279.
  • 13. Kloos RT, Ringel MD, Knopp MV, et al. Phase II trial of sorafenib in metastatic thyroid cancer. J Clin Oncol 2009;27:1675-84. doi: 10.1200/JCO.2008.18.2717.
  • 14. Brose MS, Nutting CM, Jarzab B, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 2014;384:319-28. doi: 10.1016/S0140- 6736(14)60421-9.
  • 15. Schlumberger M, Tahara M, Wirth LJ et al. Lenvatinib versus placebo in radioiodinerefractory thyroid cancer. N Engl J Med 2015;372:621-30. doi: 10.1056/NEJMoa1406470

A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer

Year 2019, Volume: 32 Issue: 1, 33 - 37, 29.01.2019
https://doi.org/10.5472/marumj.518826

Abstract

Objective: Thyroid cancer is the most common type of endocrine
cancer. The current approaches in the systemic therapies of
metastatic thyroid cancers are chemotherapy that is investigated in
phase II clinical trials and tyrosine kinase inhibitors, investigated
in phase III clinical trials. The aim of this study was to evaluate the
efficacy of systemic therapies in metastatic thyroid cancer patients.
Materials and Methods: We investigated 57 patients
retrospectively, diagnosed with thyroid cancer who were referred to
Maslak Acibadem Hospital Medical Oncology Department between
2008-2015 and Umraniye Training and Research Hospital between
2016-2018. They had received systemic treatment due to the refractory
profile to radioiodine therapy and metastatic thyroid cancer.
Results: Medical records of 57 patients with metastatic thyroid
cancer, who were referred for systemic therapy were retrospectively
analysed. 52% (n:30) of the cases were women and 48% (n:27)
were men, and the mean age was 57.11 years. All patients was
above the age of 18. Of the patients, 59.8% (n:35) had well
differentiated thyroid cancer, 29.8% (n:17) had medullary thyroid
cancer, 5.3% (n:3) had anaplastic thyroid cancer, 3.5% (n:2) had
poorly differentiated thyroid cancer and 1.8% (n:1) had medullarypapillary
synchronous cancer. When first line systemic therapy
was evaluated for all 57 patients, progression free survival (PFS)
was found 4.25 and 6.33 months for chemotherapy and sorafenib,
respectively (P:0.035). All cases were evaluated retrospectively
for second line systemic therapy and PFS was 4.1 and 7.77 months
for chemotherapy and sorafenib, respectively (P<0.001).
Conclusion: Tyrosine kinase inhibitors are used in the treatment
of radioactive iodine-refractory differentiated thyroid cancers and
medullary thyroid cancers. The effect of lenvatinib, sorafenib and
vandetanib on progression-free survival in thyroid cancers is found
to be superior to systemic chemotherapy. It was concluded that
sorafenib is a systemic treatment option which can be preferred in
terms of efficacy and toxicity profile in radioactive iodine refractory
well-differentiated thyroid cancer especially in our country.

References

  • 1. Shah JP. Thyroid carcinoma: Epidemiology, histology, and diagnosis. Clin Adv Hematol Oncol 2015; 13(4 Suppl 4): 3-6.
  • 2. Brown RL, De Souza JA, Cohen EE. Thyroid cancer: Burden of illness and management of disease. J Cancer 2011;2:193- 199. doi: https://doi.org/10.1530/ERC-16-0372.
  • 3. Pacini F, Castagna MG, Brilli L, Pentheroudakis G. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23 (suppl 1): vii110–9. doi.org/10.1093/annonc/mds230.
  • 4. Barut F. Tiroid kanserlerinin patolojisi. Turkiye Klinikleri J Med Oncol-Special Topics 2017;10:10-2.
  • 5. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 ;19:1167-214. doi: 10.1089/ thy.2009.0110.
  • 6. Albero A, Lopéz JE, Torres A, et al. Effectiveness of chemotherapy in advanced differentiated thyroid cancer: a systematic review. Endoc Relat Cancer 2016;23:R71-84. doi: 10.1530/ERC-15-0194.
  • 7. Kormaz T, Er Ö. Tiroid kanserlerinde tirozin kinaz inhibitör tedavisi, kemoterapi ve gelecekteki olası tedaviler. Turkiye Klinikleri J Med Oncol-Special Topics 2017;10:50-5.
  • 8. Baran A., Yılmaz M. Tiroid kanserlerinde kemoterapi ve hedefe yönelik tedaviler. Türkiye Kanserle Savaş Vakfı Kanser Gündemi Tiroid Kanseri 2015;3/3:62-4.
  • 9. Gottlieb JA, Hill CS Jr. Chemotherapy of thyroid cancer with adriamycin. Experience with 30 patients. N Eng Med J 1974;290:193-7. doi:10.1056 /NEJM 197.401.242900404
  • 10. Shimaoka K, Schoenfeld DA, DeWys WD, et al. A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 1985;56:2155-60. doi: 10.1002/1097- 0142(19851101)56:9<2155.
  • 11. Matuszczyk A, Petersenn S, Voigt W, et al. Chemotherapy with paclitaxel and gemcitabine in progressive medullary and thyroid carcinoma of the follicular epithelium. Horm Metab Res 2010;42:61-4. doi: 10.1055/s-0029.123.8294.
  • 12. Abramson V, Troxel AB, Nellore A, et al. Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol 2008;26:4714-9. doi: 10.1200/JCO.2008.16.3279.
  • 13. Kloos RT, Ringel MD, Knopp MV, et al. Phase II trial of sorafenib in metastatic thyroid cancer. J Clin Oncol 2009;27:1675-84. doi: 10.1200/JCO.2008.18.2717.
  • 14. Brose MS, Nutting CM, Jarzab B, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 2014;384:319-28. doi: 10.1016/S0140- 6736(14)60421-9.
  • 15. Schlumberger M, Tahara M, Wirth LJ et al. Lenvatinib versus placebo in radioiodinerefractory thyroid cancer. N Engl J Med 2015;372:621-30. doi: 10.1056/NEJMoa1406470
There are 15 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Articles
Authors

Atakan Demir

Publication Date January 29, 2019
Published in Issue Year 2019 Volume: 32 Issue: 1

Cite

APA Demir, A. (2019). A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer. Marmara Medical Journal, 32(1), 33-37. https://doi.org/10.5472/marumj.518826
AMA Demir A. A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer. Marmara Med J. January 2019;32(1):33-37. doi:10.5472/marumj.518826
Chicago Demir, Atakan. “A Retrospective Analysis of Efficacy of Systemic Therapy in Metastatic Thyroid Cancer”. Marmara Medical Journal 32, no. 1 (January 2019): 33-37. https://doi.org/10.5472/marumj.518826.
EndNote Demir A (January 1, 2019) A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer. Marmara Medical Journal 32 1 33–37.
IEEE A. Demir, “A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer”, Marmara Med J, vol. 32, no. 1, pp. 33–37, 2019, doi: 10.5472/marumj.518826.
ISNAD Demir, Atakan. “A Retrospective Analysis of Efficacy of Systemic Therapy in Metastatic Thyroid Cancer”. Marmara Medical Journal 32/1 (January 2019), 33-37. https://doi.org/10.5472/marumj.518826.
JAMA Demir A. A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer. Marmara Med J. 2019;32:33–37.
MLA Demir, Atakan. “A Retrospective Analysis of Efficacy of Systemic Therapy in Metastatic Thyroid Cancer”. Marmara Medical Journal, vol. 32, no. 1, 2019, pp. 33-37, doi:10.5472/marumj.518826.
Vancouver Demir A. A retrospective analysis of efficacy of systemic therapy in metastatic thyroid cancer. Marmara Med J. 2019;32(1):33-7.