Clinical guidance for radioiodine refractory differentiated thyroid cancer |
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| Authors: | Matti L. Gild Duncan J. Topliss Diana Learoyd Francis Parnis Jeanne Tie Brett Hughes John P. Walsh Donald S.A. McLeod Roderick J. Clifton‐Bligh Bruce G. Robinson |
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| Affiliation: | 1. Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital Sydney, St Leonards, NSW, Australia;2. The University of Sydney, Sydney, NSW, Australia;3. Department of Endocrinology and Diabetes, The Alfred, Melbourne, VIC, Australia;4. Department of Medicine, Monash University, Melbourne, VIC, Australia;5. Department of Oncology, Adelaide Cancer Centre, Kurralta Park, SA, Australia;6. Adelaide University, Adelaide, SA, Australia;7. Division of Systems Biology and Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia;8. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia;9. Department of Medical Oncology, Western Health, Melbourne, VIC, Australia;10. Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia;11. School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, Australia;12. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia;13. School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia;14. Department of Endocrinology, Diabetes Royal Brisbane and Women's Hospital, Herston, QLD, Australia;15. Population Health Department QIMR Berghofer Medical Research Institute, Herston, QLD, Australia;16. Cancer Genetics Laboratory, Hormones and Cancer Group, Kolling Institute of Medical Research, Sydney, SW, Australia |
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| Abstract: | Prognosis from differentiated thyroid cancer is worse when the disease becomes refractory to radioiodine. Until recently, treatment options have been limited to local therapies such as surgery and radiotherapy, but the recent availability of systemic therapies now provides some potential for disease control. Multitargeted kinase inhibitors (TKIs) including lenvatinib and sorafenib have been shown to improve progression‐free survival in phase III clinical trials, but are also associated with a spectrum of adverse effects. Other TKIs have been utilized as “redifferentiation” agents, increasing sodium iodide symporter expression in metastases and thus restoring radioiodine avidity. Some patients whose disease progresses on initial TKI therapy will still respond to a different TKI and clinical trials currently in progress will clarify the best options for such patients. As these drugs are not inexpensive, care needs to be taken to minimize not only biological but also financial toxicity. In this review, we examine the basic biology of radioiodine refractory disease and discuss optimal treatment approaches, with specific focus on choice and timing of TKI treatment. This clinical field remains fluid, and directions for future research include exploring biomarkers and considering adjuvant TKI use in certain patient groups. |
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| Keywords: | differentiated radioiodine refractory thyroid cancer tyrosine kinase inhibitor |
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