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Real-world practice patterns and outcomes for RAI-refractory differentiated thyroid cancer
Andrew G Gianoukakis1, Jennifer H Choe2, Daniel W Bowles3
1The Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California, USA.
European Thyroid Journal
|December 14, 2023
Summary
Active surveillance is a viable option for patients with progressive radioactive iodine-refractory differentiated thyroid cancer. However, early multi-kinase inhibitor therapy may benefit some patients, necessitating further research for optimal treatment selection.
Area of Science:
- Oncology
- Endocrinology
- Pharmacology
Background:
- Differentiated thyroid cancer (DTC) that is refractory to radioactive iodine (RAI-R) presents treatment challenges.
- The optimal timing for initiating multi-kinase inhibitors (MKIs) in patients with progressive RAI-R DTC is not well-defined.
- Real-world practice patterns and outcomes for asymptomatic, progressive RAI-R DTC patients are evaluated.
Purpose of the Study:
- To compare real-world practice patterns of MKI therapy versus active surveillance in patients with progressive RAI-R DTC.
- To evaluate the time to symptomatic progression (TTSP) in patients managed with active surveillance versus early MKI initiation.
- To identify potential differences in outcomes between US and non-US patient populations.
Main Methods:
- Prospective, non-interventional, open-label study involving patients with progressive RAI-R DTC.
- Patients were assigned by physicians to either MKI therapy (cohort 1) or active surveillance (cohort 2).
- Primary endpoint was time to symptomatic progression (TTSP); 36-month rates were calculated for inestimable endpoints.
Main Results:
- Of 647 patients, 478 (74%) were in the active surveillance cohort and 169 (26%) received MKI therapy.
- US patients had a higher rate of active surveillance (92.6%) compared to non-US patients (66.9%).
- In cohort 2, 36-month TTSP rates were similar (65.6% US vs. 66.5% non-US); however, later MKI treatment in cohort 2 showed lower TTSP rates (30.8% US vs. 55.8% non-US).
Conclusions:
- Active surveillance is a feasible management strategy for asymptomatic patients with progressive RAI-R DTC.
- Early MKI intervention may be more beneficial for certain patient subgroups.
- Further research is required to identify specific patient characteristics that predict optimal response to active surveillance versus early MKI therapy.
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