Abstract
BackgroundThyroid malignancies are among the most common endocrine cancers worldwide. Owing to the angiogenic nature of these malignancies, tyrosine kinase inhibitors (TKIs) are an attractive potential treatment. However, TKIs have been associated with an increased risk of tumor cavitation, in turn linked to poor outcomes, in patients with malignancies in the lungs, where thyroid cancer commonly metastasizes.MethodWe performe d a retrospective cohort study of patients with thyroid cancer and evidence of metastatic disease to the lung that were treated with multi-targeted antiangiogenic TKIs. The primary objective of this study was to determine the incidence of pulmonary cavitation. The secondary objective was to evaluate the effect of pulmonary cavitation on survival.ResultsOf the 83 patients with pulmonary nodules, 10 developed cavitation during treatment. Of these 83 patients, two patients had to stop the treatment due to pneumothorax. Additionally, cavitation did not demonstrate any significant effect on survival.ConclusionIn patients with thyroid cancer and evidence of metastatic disease to the chest, the use of multi-targeted TKIs led to cavitations that were not uncommon but clinical consequences were marginal. Treatment was stopped only in two patients that developed pneumothorax, however the small sample is a strong limitation of our study.
Highlights
Thyroid malignancies are among the most common endocrine cancers worldwide
In patients with thyroid cancer and evidence of metastatic disease to the chest, the use of multitargeted Tyrosine kinase inhibitors (TKI) led to cavitations that were not uncommon but clinical consequences were marginal
From the specialty pharmacy database and electronical medical records at our institution, all patients with thyroid cancer treated with multitargeted antiangiogenic TKIs during January 2012 through January 2017 were selected for review
Summary
Thyroid malignancies are among the most common endocrine cancers worldwide. Owing to the angiogenic nature of these malignancies, tyrosine kinase inhibitors (TKIs) are an attractive potential treatment. TKIs have been associated with an increased risk of tumor cavitation, in turn linked to poor outcomes, in patients with malignancies in the lungs, where thyroid cancer commonly metastasizes. Thyroid tumors are highly vascular and overexpress VEGF; therapy targeting VEGF receptors (VEGFRs), by which VEGF mediates its effects on patients with lung cancer treated with antiangiogenic agents commonly develop cavitation in their lung lesions—that is, a gas-filled area in the center of a lung nodule [9–11]. Datar et al BMC Cancer (2020) 20:1181 that 17 of 124 (14%) patients with advanced lung cancer developed tumoral cavitation during antiangiogenic therapy using bevacizumab, vandetanib, sorafenib, erlotinib, AMG-706 (multi-targeted TKI), ADH-1 (N-cadherin inhibitor), or squalamine (VEGF inhibitor) [9]. Crabb et al reported marked cavitation of pulmonary lesions in eight of 33 patients (24%) treated with the VEGF inhibitor cediranib [10]
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