Abstract
The aim of this study was to describe the real-world experience multikinase inhibitors (MKI) in the treatment advanced differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAIR) therapy. We reviewed the records of all patients with MKI-treated DTC from 2010 to 2018. Progression free survival (PFS), response rates (RR) and adverse events (AE) profiles were assessed. Clinical parameters were compared between groups with different outcomes (disease progression and death) to identify possible prognostic factors and benefit from treatment. Forty-four patients received MKI for progressive RAIR DTC. Median PFS was 24 months (10.2-37.7) and median overall survival (OS) was 31 months. Best overall response was complete response in one patient (4.5%), partial response in nine (20.4%), stable disease in twenty-two (50%), and progressive disease (PD) in twelve (27.3%). Seventy-two point 7 percent patients had clinical benefit and AE were mild in most cases (82.7%). Progressive patients were more likely to have FDG positive target lesion than those who did not progress (p = 0.033) and higher maximum SUV on target lesions (p = 0.042). Presence of lung-only metastasis and lower thyroglobulin (Tg) during treatment was associated with stable disease (p = 0.015 and 0,049, respectively). Patients with shorter survival had larger primary tumor size (p = 0.015) and higher maximum SUV on target lesions (p = 0.023). Our findings demonstrate safety and effectiveness of MKI in patients with advanced RAIR DTC. We were able to identify as possible prognostic markers of better outcomes: absence of FDG uptake on target lesions, lower maximum SUV on PET-CT, presence of lung-only metastasis and lower Tg during treatment.
Highlights
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy and its incidence has been rising worldwide [1]
The following demographic and clinical data from all subjects included in the analysis were collected: gender, age at diagnosis, tumor histology, number of radioactive iodine (RAI) treatments, cumulative RAI activity, whole body survey (WBS) results after therapeutic RAI, criteria used to determine RAIR disease, tumor staging, metastatic lesion sites, target lesion size and site, other systemic or localized therapies performed, adequate TSH suppression prior to multikinase inhibitors (MKI), date and dosage of MKI treatment initiation, dosage modification when it occurred, temporary discontinuation of treatment, adverse events (AE) and its degree when present, treatment discontinuation date and motive, anti-thyroglobulin (ATg) antibody levels and serum thyroglobulin (Tg) before treatment, lower ATg and Tg during treatment, imaging studies during follow-up and structural response, time of last visit during followup, date of death
In this study we describe a retrospective cohort of patients with progressive unresectable DTC RAIR, treated with MKI for a median period of 99.6 months in a public referral center in Rio de Janeiro
Summary
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy and its incidence has been rising worldwide [1]. The following demographic and clinical data from all subjects included in the analysis were collected: gender, age at diagnosis, tumor histology, number of RAI treatments, cumulative RAI activity, whole body survey (WBS) results after therapeutic RAI, criteria used to determine RAIR disease, tumor staging, metastatic lesion sites, target lesion size and site, other systemic or localized therapies performed, adequate TSH suppression prior to MKI, date and dosage of MKI treatment initiation, dosage modification when it occurred, temporary discontinuation of treatment, adverse events (AE) and its degree when present, treatment discontinuation date and motive, anti-thyroglobulin (ATg) antibody levels and serum thyroglobulin (Tg) before treatment, lower ATg and Tg during treatment, imaging studies during follow-up and structural response, time of last visit during followup, date of death. Functional sensitivity is 0.005 μIU/mL (Elecsys TSH test) and free T4 is 0.5 pmol/L (Elecsys FT4 II test)
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