Differentiated thyroid cancer: Focus on emerging treatments for radioactive iodine-refractory patients

Joshua J. Gruber, A. Dimitrios Colevas

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

Background. The treatment of differentiated thyroid cancer refractory to radioactive iodine (RAI) had been hampered by few effective therapies. Recently, tyrosine kinase inhibitors (TKIs) have shown activity in this disease. Clinical guidance on the use of these agents in RAI-refractory thyroid cancer is warranted. Materials and Methods. Molecular mutations found in RAIrefractory thyroid cancer are summarized. Recent phase II and III clinical trial data for TKIs axitinib, lenvatinib, motesanib, pazopanib, sorafenib, sunitinib, and vandetinib are reviewed including efficacy and side effect profiles.Molecular targets and potencies of these agents are compared. Inhibitors of BRAF, mammalian target of rapamycin, and MEK are considered. Results. Routine testing for molecular alterations prior to therapy is not yet recommended. TKIs produce progressionfree survival of approximately 1 year (range: 7.7-19.6 months) and partial response rates of up to 50%by Response Evaluation Criteria in Solid Tumors. Pazopanib and lenvatinib are the most active agents. The majority of patients experienced tumor shrinkage with TKIs. Common adverse toxicities affect dermatologic, gastrointestinal, and cardiovascular systems. Conclusion. Multiple TKIs have activity in RAI-refractory differentiated thyroid cancer. Selection of a targeted agent should depend on disease trajectory, side effect profile, and goals of therapy.

Original languageEnglish (US)
Pages (from-to)113-126
Number of pages14
JournalOncologist
Volume20
Issue number2
DOIs
StatePublished - Jan 23 2015
Externally publishedYes

Keywords

  • BRAF inhibitors
  • Follicular thyroid cancer
  • MEK inhibitors
  • Papillary thyroid cancer
  • Radioactive iodine refractory differentiated thyroid cancer
  • Tyrosine kinase inhibitors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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