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Published on: January 29, 2019
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Enhancing Radioiodine Incorporation into Radioiodine-Refractory Thyroid Cancer with MAPK Inhibition (ERRITI): A
Manuel Weber1,2, David Kersting1,2, Burkhard Riemann3
1Clinic for Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Summary
Genotype-guided MAPK inhibition safely restored iodine uptake in radioiodine-refractory thyroid cancer, with subsequent 131I therapy improving thyroglobulin levels in over half of patients. Low tumor FDG uptake predicts successful redifferentiation.
Area of Science:
- Oncology
- Molecular Biology
- Nuclear Medicine
Background:
- Radioiodine-refractory thyroid carcinoma (RR-TC) presents a therapeutic challenge.
- MAPK pathway modulation offers a strategy for redifferentiation, restoring iodine incorporation.
- Previous attempts showed limited success in BRAFV600E-mutant (BRAF-MUT) RR-TC.
Discussion:
- This study investigated genotype-guided MAPK inhibition (trametinib +/- dabrafenib) for redifferentiation in BRAF-MUT and wildtype (BRAF-WT) RR-TC.
- Redifferentiation was assessed by 123I-scintigraphy, followed by 124I-guided 131I therapy if successful.
- Predictive markers for successful redifferentiation were analyzed.
Key Insights:
- Redifferentiation was achieved in 35% of patients (33% BRAF-MUT, 36% BRAF-WT).
- Following 131I therapy, 57% of patients showed a decline in thyroglobulin (Tg).
- Low tumor glycolytic rate (SUVpeak < 10 on FDG-PET) predicted successful redifferentiation (P=0.01).
Outlook:
- Genotype-guided MAPK inhibition is a safe and effective strategy for redifferentiation in RR-TC.
- FDG-PET offers a valuable tool for patient selection for redifferentiation therapy.
- Further research may optimize combination therapies for improved outcomes in advanced thyroid cancer.
