| مستخلص: |
Thyroid cancer is rare, but the incidence has increased in recent years. There are 3 common types of thyroid cancer, which are differentiated thyroid cancer (DTC) (80%), medullary thyroid carcinoma (MTC)(4%), and anaplastic thyroid carcinoma (ATC)(2%). DTCs usually have an favorable prognosis. Historically, DTC was treated with resection, followed by radioactive iodine (RAI) therapy and TSH suppression. However, 15-20% of those patients with metastatic DTC developed refractory to RAI (RAI-R). Currently, the availability of multi-tyrosine kinase inhibitors (sorafenib, or lenvatinib)that can stabilize progressive metastatic disease has been changed to the standard approach. However, these agents are usually tumoristatic rather than tumoricidal, and no published study has showed the improvement of overall survival. Moreover, these agents have significant toxicities, therefore, it should be limited the use of these agents in symptomatic patients due to progressive metastatic disease. For MTC patients with symptomatic metastatic disease who cannot be treated with resection or radiation, systemic therapy with oral tyrosine kinase inhibitors (cabozantinib, or vandetanib) should be considered. ATCs are extremely aggressive and almost always rapidly fatal. Enrollment in the clinical studies of targeted therapy is strongly encouraged for those ATC patients who have a good performance status. In conclusions, TKIs demonstrate a promising approach to the treatment of advanced RAI_R DTC, MTC, and probably in ATC. Currently, sorafenib and lenvatinib have been approved by the FDA and the EMA for the treatment of RAI-R DTC. Vandetanib and cabozantinib have been approved for treating advanced. and progressive MTC. Further understanding of biomarkers and molecular basis will lead to the development of novel agents, which could be potential targeted to achieve tumor-selective cytotoxicity and less toxicities to ameliorate the patient's quality of life. [ABSTRACT FROM AUTHOR] |
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