Sorafenib for patients with differentiated thyroid cancer

Abstract

Marcia Brose and colleagues1Brose MS Nutting CM Jarzab B et al.on behalf of the DECISION investigatorsSorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial.Lancet. 2014; 384: 319-328Summary Full Text Full Text PDF PubMed Scopus (943) Google Scholar reported their findings of a randomised phase 3 trial of sorafenib in patients with differentiated thyroid cancer. Sorafenib was approved on Nov 22, 2014, for use in patients with differentiated radioactive iodine-resistant, metastatic thyroid cancer, and is included in the National Comprehensive Cancer Network and the American Thyroid Association guidelines.2Thomas L Lai SY Dong W et al.Sorafenib in metastatic thyroid cancer: a systematic review.Oncologist. 2014; 19: 251-258Crossref PubMed Scopus (68) Google Scholar However, the clinical effects of sorafenib in the treatment of differentiated thyroid cancer, are modest, with a low overall tumour response rate and modest prolongation of patient survival.1Brose MS Nutting CM Jarzab B et al.on behalf of the DECISION investigatorsSorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial.Lancet. 2014; 384: 319-328Summary Full Text Full Text PDF PubMed Scopus (943) Google Scholar Therefore, a crucial challenge is to identify novel predictive biomarkers, at the cellular or molecular levels, which could be used to identify patients who will benefit most from anti-angiogenic treatment for thyroid cancer, thereby improving treatment efficacy and avoiding unnecessary toxic effects. Alternatively, adverse events could act as surrogate biomarkers for drug activity, enabling outcomes to be predicted during treatment, because the occurrence of treatment-related side-effects is associated with the pharmacokinetic and pharmacodynamic effects of a drug.3Ravaud A Schmidinger M Clinical biomarkers of response in advanced renal cell carcinoma.Ann Oncol. 2013; 24: 2935-2942Crossref PubMed Scopus (45) Google Scholar, 4Flaherty KT Sun W Which questions remain unanswered following the successful development of sorafenib in hepatocellular carcinoma?.Nat Clin Pract Oncol. 2009; 6: 64-65Crossref PubMed Scopus (4) Google Scholar, 5Dienstmann R Braña I Rodon J et al.Toxicity as a biomarker of efficacy of molecular targeted therapies: focus on EGFR and VEGF inhibiting anticancer drugs.Oncologist. 2011; 16: 1729-1740Crossref PubMed Scopus (104) Google Scholar The occurrence of specific adverse events, such as hand–foot skin reaction, during sorafenib treatment might be associated with improved efficacy.6Vincenzi B Santini D Russo A et al.Early skin toxicity as a predictive factor for tumor control in hepatocellular carcinoma patients treated with sorafenib.Oncologist. 2010; 15: 85-92Crossref PubMed Scopus (145) Google Scholar Therefore, of interest would be the assessment of the large prospective data set reported by Brose and colleagues1Brose MS Nutting CM Jarzab B et al.on behalf of the DECISION investigatorsSorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial.Lancet. 2014; 384: 319-328Summary Full Text Full Text PDF PubMed Scopus (943) Google Scholar to establish whether the development of treatment-specific adverse events correlated with treatment outcomes. The investigators1Brose MS Nutting CM Jarzab B et al.on behalf of the DECISION investigatorsSorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial.Lancet. 2014; 384: 319-328Summary Full Text Full Text PDF PubMed Scopus (943) Google Scholar could address this issue by providing survival data according to the emergence of treatment-related adverse events. Such data could assist clinicians in making treatment decisions, and in the development of future targeted treatments for thyroid cancer. We declare no competing interests. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trialSorafenib significantly improved progression-free survival compared with placebo in patients with progressive radioactive iodine-refractory differentiated thyroid cancer. Adverse events were consistent with the known safety profile of sorafenib. These results suggest that sorafenib is a new treatment option for patients with progressive radioactive iodine-refractory differentiated thyroid cancer. Full-Text PDF Sorafenib for patients with differentiated thyroid cancer – Authors' replyWe appreciate the interest of Olivier Huillard, Pascaline Boudou-Rouquette, and Hyo Jin Lee and their colleagues for their thoughtful comments about our Article.1 Full-Text PDF