Advanced Differentiated Thyroid Cancer: Molecular Targeted Therapies

Publish Year: 1396
نوع سند: مقاله کنفرانسی
زبان: English
View: 408

نسخه کامل این Paper ارائه نشده است و در دسترس نمی باشد

  • Certificate
  • من نویسنده این مقاله هستم

این Paper در بخشهای موضوعی زیر دسته بندی شده است:

استخراج به نرم افزارهای پژوهشی:

لینک ثابت به این Paper:

شناسه ملی سند علمی:

IPMCMED02_130

تاریخ نمایه سازی: 29 فروردین 1397

Abstract:

Thyroid cancer is the most common endocrine malignancy, Differentiated thyroid carcinoma (DTC) arises from follicular cells and are further classified as either papillary (PTCs, 75-80%) or follicular thyroid cancers (FTCs, 5-10%). The survival rates of patients are highly variable and depend on the histotype and the degree of differentiation.Generally, in 10% of cases, the patients have an advanced stage of the cancer at the time of diagnosis, with local invasion and/or distant metastases. In about one-third of advanced DTCs, the metastatic lesions have a very low avidity for iodine at the time of diagnosis and 131I therapy has no effects.Risk stratification in thyroid carcinoma is crucial to avoid overtreatment of low-risk and undertreatment of high-risk patients. Initial risk stratification, based on histopathological data is carried out just after primary surgery.During the follow-up, patients are rest ratified considering their response to treatment to one of the following categories: excellent response, biochemical incomplete response, structural incomplete, or indeterminate response. This new approach is called dynamic risk stratification. It reflects a real-time prognosis and thereby substantially influences and personalizes disease management.The advent of individual genomic analysis provides hope that we are entering a new era of personalized, patient-specific care. Reliable identification of mutations typically associated with thyroid cancer could alter the initial cancer treatment specially for high-risk patients and can potentially prevent the recurrences. The lack of effective therapies for PTC, resistant to radioiodine therapies, is now being overcome by the development of targeted novel compounds in the context of personalized treatment. Using approved targeted therapies such as anti-BRAF (V600-E) selective inhibitors and tyrosine kinase inhibitors (single or in combination) based on the individual characteristics of each patient may help to improve overall survival rates.In general, good candidates for targeted therapies are those thyroid tumors that are defined as radioactive iodine resistant (RAI-R) according to well-defined criteria. This group generally includes approximately 66% of DTCs that have distant metastases at the time of diagnosis, which cannot be cured with 131I because they were initially or become RAI-R over time. Only patients with an advanced and progressive disease should undergo a treatment with targeted therapies.Sorafenib and lenvatinib have been approved by the FDA and the EMA for the treatment of progressive RAI-R-DTC. Determining the right time to start targeted treatments represents a goal for future clinical research.

Authors

Mohammad E Khamseh

Institute of Endocrinology and Metabolism Iran University of Medical sciences

Maryam Honardoust

Institute of Endocrinology and Metabolism Iran University of Medical sciences