Advanced medullary thyroid cancer treated with Sorafenib: A case report

Abstract

Background: Medullary thyroid carcinoma (MTC) accounts for 5% of all thyroid carcinomas. As no effective systemic therapy exists, surgery is the only curative treatment for MTC. In the last few years, several clinical trials have tested the efficacy of new multi-targeted agents such as sorafenib, vandetanib, motesanib, sunitinib and pazopanib in patients with metastatic MTC. Summary: In June 2010, a 38-year-old male patient complained on pain on swallowing and coughs. Physical examination detected a hard nodule of 2 cm on the left side of his neck. A fine-needle aspiration of it yielded evidence of carcinoma. A computed tomography scan showed multiple lyphadenopathies. In August 2010, the patient underwent an incomplete thyroidectomy and received radiotherapy. In spite of that, he was still unable to swallow either solids or liquids, and suffered dyspnoea on moderate exertion. In May 2011, the patient started receiving sorafenib and levothyroxine. After 20 days, his clinical symptoms were less severe and palpable lymphadenopathies shrank by 50%. After 5 months, the patient still had no dysphagia or dyspnoea, but developed fatigue and elevated transaminases. Sorafenib was discontinued and the liver was examined by ultrasonography with no abnormal findings. After a two-week rest period, the patient resumed sorafenib from November 2011 to December 2012, achieving a clinical, biochemical and radiological response. Conclusion: This case provides limited evidence for a potential role for sunitinib in the treatment of patients with metastatic MTC.