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Differentiated thyroid cancer: focus on emerging treatments for radioactive iodine-refractory patients

Joshua J Gruber1, A Dimitrios Colevas2

  • 1Stanford Cancer Center, Stanford University Medical Center, Stanford, California, USA.

The Oncologist
|January 25, 2015
PubMed
Abstract

Insights

Tyrosine kinase inhibitors (TKIs) offer new hope for radioactive iodine-refractory differentiated thyroid cancer, showing significant tumor shrinkage and progression-free survival. Pazopanib and lenvatinib are particularly effective among these targeted therapies.

Area of Science:

  • Oncology
  • Molecular Biology
  • Pharmacology

Background:

  • Differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) presents limited treatment options.
  • Tyrosine kinase inhibitors (TKIs) have emerged as a promising therapeutic strategy for RAI-refractory DTC.
  • Clinical guidance is needed for the effective use of TKIs in this patient population.

Purpose of the Study:

  • To summarize molecular alterations in RAI-refractory DTC.
  • To review clinical trial data for various TKIs used in RAI-refractory DTC.
  • To compare the efficacy, side effect profiles, and molecular targets of these TKIs.

Main Methods:

  • Review of molecular mutations in RAI-refractory DTC.
  • Analysis of Phase II and III clinical trial data for axitinib, lenvatinib, motesanib, pazopanib, sorafenib, sunitinib, and vandetanib.
  • Comparison of molecular targets and potencies of TKIs, including BRAF, mTOR, and MEK inhibitors.

Main Results:

  • TKIs demonstrate efficacy in RAI-refractory DTC, with progression-free survival around 1 year and partial response rates up to 50%.
  • Pazopanib and lenvatinib show the highest activity among the reviewed TKIs.
  • Common adverse events associated with TKIs involve dermatologic, gastrointestinal, and cardiovascular systems.

Conclusions:

  • Multiple TKIs exhibit therapeutic activity in differentiated thyroid cancer resistant to radioactive iodine.
  • The choice of TKI should be individualized based on disease progression, patient tolerance to side effects, and therapeutic goals.
Keywords:
BRAF inhibitorsFollicular thyroid cancerMEK inhibitorsPapillary thyroid cancerRadioactive iodine refractory differentiated thyroid cancerTyrosine kinase inhibitors

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