Sažetak sa skupa
Contemporary systemic therapeutic options in the management of thyroid cancer
Nina Dabelić
; KBC Sestre milosrdnice, Klinika za onkologiju i nuklearnu medicinu,Vinogradska 29, 10000 Zagreb, Hrvatska
Tomislav Jukić
; KBC Sestre milosrdnice, Klinika za onkologiju i nuklearnu medicinu,Vinogradska 29, 10000 Zagreb, Hrvatska; Medicinski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Ana Fröbe
; KBC Sestre milosrdnice, Klinika za onkologiju i nuklearnu medicinu,Vinogradska 29, 10000 Zagreb, Hrvatska; Stomatološki fakultet Sveučilišta u Zagrebu, Hrvatska
Sažetak
Cytotoxic chemotherapy has been virtually abandoned for the treatment of thyroid cancer due to toxicity and
lack of efficacy. With the exception of anaplastic thyroid cancer, only patients with rapidly progressive (within
one year per RECIST criteria) and/or symptomatic disease are candidates for therapy, due to an often indolent
disease course. Asymptomatic patients with slowly-progressive disease should be closely monitored. Systemic
treatment of advanced and progressive unresectable or metastatic radioiodine-refractory DTC is currently
based on multiple kinase inhibitors (MKI) lenvatinib, cabozantinib, or sorafenib. The use of specific inhibitors
directed against a RET or TRK gene fusion has produced extensive tumor responses. In patients with
a BRAFV600E mutation, a BRAF-inhibitor (dabrafenib) alone or in combination with a MEK-inhibitor
(trametinib) has induced a tumor response in up to 54% of patients. Moreover, the inhibition of the MAPK
pathway with these drugs may induce the redifferentiation of refractory thyroid tumor cells and the
reappearance of tumor radioiodine uptake. Larotrectinib and entrectinib are tumor-agnostic tropomyosin
receptor kinase (TRK) inhibitors that are used agnostically for the treatment of advanced or metastatic solid
tumor cancers with neurotrophic tyrosine receptor kinase (NTRK) gene fusions. NTRK fusion can be present
in either DTC (usually papillary TC) or in ATC. In medullary thyroid carcinoma (MTC) patients, multikinase
inhibitors (MKI) vandetanib and cabozantinib are used for the treatment of progressive or symptomatic
metastatic/unresectable MTC. Two selective RET-kinase inhibitors, selpercatinib and pralsetinib, are available
for the treatment of RET-mutant MTC. They are more efficient and less toxic than MKIs. In anaplastic thyroid
carcinoma (ATC) with BRAFV600E mutation, therapy with dabrafenib and trametinib should be the treatment
of choice: this combination has been approved by the FDA. Immunotherapy can sometimes be effective in
tumors with a high mutational burden. Multidisciplinary tumor boards (MTB) of various specialists involved
in the diagnostics and treatment of patients with TC in highly specialized centers with a high volume of patients
provide optimal patient management.
Ključne riječi
differentiated thyroid cancer; medullary thyroid cancer; RET-proto-oncogene, molecular targeted therapy; anaplastic thyroid cancer; treatment
Hrčak ID:
336291
URI
Datum izdavanja:
10.11.2025.
Posjeta: 148 *