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The treatment landscape in thyroid cancer: a focus on cabozantinib.

Weitzman SP, Cabanillas ME - Cancer Manag Res (2015)

Bottom Line: Close monitoring is required for all patients on targeted agents to assess for adverse effects and response to therapy.An approach to managing drug-related adverse events is detailed.Since these drugs are not curative and have not yet proven to prolong overall survival, it is critical to weigh the risks and benefits of treatment at every visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

ABSTRACT
Although patients with thyroid cancer generally fare well, there is a subset for which this is not necessarily true. Progress in understanding the molecular aberrations in thyroid cancer has led to a change in the management of these cases. Since 2011, four multikinase inhibitors (MKIs) have been approved by the US Food and Drug Administration for thyroid cancer - cabozantinib and vandetanib for medullary thyroid cancer and sorafenib and lenvatinib for differentiated thyroid cancer. This change in the treatment landscape has raised challenges for practitioners who may not be familiar with the use of MKIs or with the treatment and natural history of advanced thyroid cancer in general. This article reviews the epidemiology, molecular drivers, and initial treatment of patients with thyroid cancer and offers practical guidance to assist with the determination of when to appropriately start an MKI. As an example, cabozantinib and its efficacy are discussed in detail. Close monitoring is required for all patients on targeted agents to assess for adverse effects and response to therapy. An approach to managing drug-related adverse events is detailed. Since these drugs are not curative and have not yet proven to prolong overall survival, it is critical to weigh the risks and benefits of treatment at every visit. The potential value of changing to a different agent following failure of an MKI is also addressed.

No MeSH data available.


Related in: MedlinePlus

Management of locally advanced and/or metastatic differentiated MTCs and the criteria for initiation of kinase inhibitors.Abbreviations: DTC, differentiated thyroid cancer; MTC, medullary thyroid cancer; RAI, radioiodine; RANKL, receptor activator of nuclear factor kappa-B ligand; TSH, thyroid-stimulating hormone.
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f2-cmar-7-265: Management of locally advanced and/or metastatic differentiated MTCs and the criteria for initiation of kinase inhibitors.Abbreviations: DTC, differentiated thyroid cancer; MTC, medullary thyroid cancer; RAI, radioiodine; RANKL, receptor activator of nuclear factor kappa-B ligand; TSH, thyroid-stimulating hormone.

Mentions: Our approach to patients with advanced thyroid cancer is elaborated in Figure 2. Although there are situations in which the need for targeted therapy seems clear, the patient’s performance status must be assessed to determine if they are likely to tolerate targeted therapy.65 Since the kinase inhibitors are not considered curative, are employed as chronic therapies, and tend to fail over time, they are generally reserved for patients in whom other modalities have failed. If disease control can be achieved surgically, this is preferred. In the case of DTC, the use of RAI should be considered for those whose tumor is RAI-avid. Any reasonable and feasible localized therapies, such as external beam radiotherapy, thermal ablation, or tumor embolization, should be undertaken if the disease is threatening vital structures (eg, spinal cord, brain), impairing mobility (eg, affecting the arm, leg, shoulder), or causing pain. It is important to remember that an elevated or rising tumor marker alone should not trigger systemic therapy.18


The treatment landscape in thyroid cancer: a focus on cabozantinib.

Weitzman SP, Cabanillas ME - Cancer Manag Res (2015)

Management of locally advanced and/or metastatic differentiated MTCs and the criteria for initiation of kinase inhibitors.Abbreviations: DTC, differentiated thyroid cancer; MTC, medullary thyroid cancer; RAI, radioiodine; RANKL, receptor activator of nuclear factor kappa-B ligand; TSH, thyroid-stimulating hormone.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4547654&req=5

f2-cmar-7-265: Management of locally advanced and/or metastatic differentiated MTCs and the criteria for initiation of kinase inhibitors.Abbreviations: DTC, differentiated thyroid cancer; MTC, medullary thyroid cancer; RAI, radioiodine; RANKL, receptor activator of nuclear factor kappa-B ligand; TSH, thyroid-stimulating hormone.
Mentions: Our approach to patients with advanced thyroid cancer is elaborated in Figure 2. Although there are situations in which the need for targeted therapy seems clear, the patient’s performance status must be assessed to determine if they are likely to tolerate targeted therapy.65 Since the kinase inhibitors are not considered curative, are employed as chronic therapies, and tend to fail over time, they are generally reserved for patients in whom other modalities have failed. If disease control can be achieved surgically, this is preferred. In the case of DTC, the use of RAI should be considered for those whose tumor is RAI-avid. Any reasonable and feasible localized therapies, such as external beam radiotherapy, thermal ablation, or tumor embolization, should be undertaken if the disease is threatening vital structures (eg, spinal cord, brain), impairing mobility (eg, affecting the arm, leg, shoulder), or causing pain. It is important to remember that an elevated or rising tumor marker alone should not trigger systemic therapy.18

Bottom Line: Close monitoring is required for all patients on targeted agents to assess for adverse effects and response to therapy.An approach to managing drug-related adverse events is detailed.Since these drugs are not curative and have not yet proven to prolong overall survival, it is critical to weigh the risks and benefits of treatment at every visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

ABSTRACT
Although patients with thyroid cancer generally fare well, there is a subset for which this is not necessarily true. Progress in understanding the molecular aberrations in thyroid cancer has led to a change in the management of these cases. Since 2011, four multikinase inhibitors (MKIs) have been approved by the US Food and Drug Administration for thyroid cancer - cabozantinib and vandetanib for medullary thyroid cancer and sorafenib and lenvatinib for differentiated thyroid cancer. This change in the treatment landscape has raised challenges for practitioners who may not be familiar with the use of MKIs or with the treatment and natural history of advanced thyroid cancer in general. This article reviews the epidemiology, molecular drivers, and initial treatment of patients with thyroid cancer and offers practical guidance to assist with the determination of when to appropriately start an MKI. As an example, cabozantinib and its efficacy are discussed in detail. Close monitoring is required for all patients on targeted agents to assess for adverse effects and response to therapy. An approach to managing drug-related adverse events is detailed. Since these drugs are not curative and have not yet proven to prolong overall survival, it is critical to weigh the risks and benefits of treatment at every visit. The potential value of changing to a different agent following failure of an MKI is also addressed.

No MeSH data available.


Related in: MedlinePlus