Metastatik tiroid kanserinde sistemik tedavi etkinliğinin retrospektif olarak değerlendirilmesi

Yıl 2019, , 33 - 37, 29.01.2019

Atakan Demir

https://doi.org/10.5472/marumj.518826

Öz

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.

Anahtar Kelimeler

Tiroid, Kanser, Sorafenib

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

Öz

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.

Anahtar Kelimeler

Thyroid, Cancer, Sorafenib

Kaynakça

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