Tailored management of advanced thyroid cancer patients treated with lenvatinib or vandetanib: the role of a multimodal approach.

IF 3.7 3区医学 Q2 Medicine Endocrine Pub Date : 2024-10-02 DOI:10.1007/s12020-024-04061-2

Alice Nervo, Matteo Ferrari, Elisa Vaccaro, Enrica Migliore, Giovanni Gruosso, Anna Roux, Alessandro Piovesan, Emanuela Arvat

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Abstract

Background: In differentiated/poorly differentiated (DTC/PDTC) or medullary thyroid cancer (MTC) treated with kinase inhibitors (KIs), additional treatments (ATs) can be performed in selected cases.

Methods: We retrospectively analysed all the ATs performed in our center in KI-treated TC patients, evaluating the subsequent KI modulation, the local PD in case of loco-regional procedure (LRP) and the AT-related complications. DTC/PDTC patients with or without progressive disease before the first AT (PD and NO PD GROUP, respectively) were analysed separately.

Results: In our center, 32 ATs (30 LRPs and 2 radioactive iodine treatments) were performed in 14 DTC/PDTC patients and 4 MTC subjects after the start of systemic therapy with lenvatinib or vandetanib (27 and 5 ATs, respectively). Brain was the most treated site (11/30 LRPs) and external beam radiation was the most employed LRP (18/30 LRPs). KIs dose reduction or discontinuation of KI therapy (at least transient) was performed after 50% of ATs in DTC/PDTC NO PD GROUP. The KI was maintained at the same dosage after 75% and 50% of the ATs performed in DTC/PDTC PD GROUP and MTC, respectively. During the follow-up, local PD was detected after 14 LRPs. Local progression-free survival (LPFS) was significantly shorter in DTC/PDTC PD GROUP in comparison to NO PD GROUP (12 month-LPFS 91.7% versus 15.2%); in patients with MTC, 12 month-LPFS was 50%. AT-related AEs were mostly G1-G2.

Conclusions: In selected DTC/PDTC without previous PD and treated with a multimodal strategy, local disease control is generally maintained regardless the KI dose modulation. In DTC/PDTC patients with previous limited PD and in MTC subjects, the choice of performing a LRP and continue the ongoing KI therapy must consider the risk of early local progression. AT-related AEs in KI treated patients were mild in most cases.

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对接受来伐替尼或凡德他尼治疗的晚期甲状腺癌患者进行量身定制的管理：多模式方法的作用。

背景：在接受激酶抑制剂（KIs）治疗的分化型/低分化型（DTC/PDTC）或甲状腺髓样癌（MTC）患者中，可在选定病例中进行额外治疗（ATs）：我们回顾性分析了本中心对KI治疗的TC患者实施的所有AT，评估了随后的KI调节、局部区域手术（LRP）的局部PD以及AT相关并发症。我们还分别分析了在首次AT前疾病有进展或无进展的DTC/PDTC患者（分别为有进展组和无进展组）：在我们中心，14名DTC/PDTC患者和4名MTC患者在开始接受来伐替尼或凡德他尼全身治疗后，共进行了32次AT（30次LRP和2次放射性碘治疗）（分别为27次和5次）。脑部是接受治疗最多的部位（11/30 例 LRP），外照射是采用最多的 LRP（18/30 例 LRP）。在DTC/PDTC NO PD GROUP中，50%的AT发生后会减少KI剂量或停止KI治疗（至少是短暂的）。在 DTC/PDTC PD GROUP 和 MTC 分别进行了 75% 和 50% 的 AT 后，KI 的剂量保持不变。在随访期间，14 次 LRP 后检测到局部 PD。与无进展组相比，DTC/PDTC无进展组的局部无进展生存期（LPFS）明显较短（12个月LPFS为91.7%对15.2%）；MTC患者的12个月LPFS为50%。AT相关的AE大多为G1-G2：对于既往没有帕金森病史且接受过多模式治疗的选定 DTC/PDTC 患者，无论 KI 剂量如何调整，一般都能维持局部疾病控制。对于既往有局限性前列腺增生的 DTC/PDTC 患者和 MTC 受试者，在选择是否进行 LRP 和继续进行 KI 治疗时，必须考虑早期局部进展的风险。接受 KI 治疗的患者中与 AT 相关的 AE 在大多数情况下都很轻微。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.