Difference between revisions of "Thyroid cancer"

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! style="color:white; font-size:125%; background-color:#08519c" align="center" colspan="2" |'''Section editor'''
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| style="background-color:#F0F0F0" |[[File:Jeenavarghese.jpg|frameless|upright=0.3|center]]
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|<big>[[User:Jvarghese|Jeena M. Varghese, MBBS]]<br>Houston, TX</big><br>[https://www.linkedin.com/in/jeena-varghese-b2b45b9b/ LinkedIn]
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{{#lst:Editorial board transclusions|endo}}
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'''Note: most thyroid cancer regimens can be found on dedicated pages:
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*'''Histology-specific:'''
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<big>'''Note: some thyroid cancer regimens can be found on dedicated pages:
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**'''[[Thyroid cancer, differentiated|Differentiated thyroid cancer (DTC)]]
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*'''[[Thyroid_cancer,_BRAF-mutated|BRAF-mutated thyroid cancer]]
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**'''[[Thyroid cancer, medullary|Medullary thyroid cancer]]
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</big>
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*'''Biomarker-specific:'''
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**'''[[Thyroid_cancer,_BRAF-mutated|BRAF-mutated thyroid cancer]]
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**'''[[Thyroid_cancer,_RET-positive|RET-positive thyroid cancer]]
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 
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=Guidelines=
 
=Guidelines=
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'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 
==[https://www.thyroid.org/ ATA]==
 
==[https://www.thyroid.org/ ATA]==
−
*'''2015:''' Guidelines on the management of thyroid nodules and differentiated thyroid cancer [https://www.ncbi.nlm.nih.gov/pubmed/28114862 PubMed]
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*'''2015:''' Guidelines on the management of thyroid nodules and differentiated thyroid cancer [https://pubmed.ncbi.nlm.nih.gov/28114862/ PubMed]
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*'''2015:''' Guidelines for the management of medullary thyroid carcinoma [https://www.ncbi.nlm.nih.gov/pubmed/27118126 PubMed]
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*'''2015:''' Guidelines for the management of medullary thyroid carcinoma [https://pubmed.ncbi.nlm.nih.gov/27118126/ PubMed]
−
*'''2012:''' Guidelines for management of patients with anaplastic thyroid cancer [https://www.ncbi.nlm.nih.gov/pubmed/23130564 PubMed]
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*'''2012:''' Guidelines for management of patients with anaplastic thyroid cancer [https://pubmed.ncbi.nlm.nih.gov/23130564/ PubMed]
 +
==[https://www.esmo.org/ ESMO]==
 +
*'''2019:''' Filetti et al. [https://doi.org/10.1093/annonc/mdz400 Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/31549998 PubMed]
 +
**'''2012:''' Pacini et al. [https://doi.org/10.1093/annonc/mds230 Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/22997443/ PubMed]
 +
**'''2010:''' Pacini et al. [https://doi.org/10.1093/annonc/mdq190 Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/20555084/ PubMed]
  
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==[http://www.esmo.org/ ESMO]==
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==NCCN==
−
*'''2012:''' [http://annonc.oxfordjournals.org/content/23/suppl_7/vii110.full.pdf+html Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://www.ncbi.nlm.nih.gov/pubmed/22997443 PubMed]
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*[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1470 NCCN Guidelines - Thyroid Carcinoma]
 +
**'''2015:''' Haddad et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4986600/ Anaplastic Thyroid Carcinoma, Version 2.2015] [https://pubmed.ncbi.nlm.nih.gov/26358798/ PubMed]
 +
**'''2014:''' Tuttle et al. [https://doi.org/10.6004/jnccn.2014.0169 Thyroid Carcinoma, Version 2.2014] [https://pubmed.ncbi.nlm.nih.gov/25505208/ PubMed]
 +
**'''2010:''' Tuttle et al. [https://doi.org/10.6004/Jnccn.2010.0093 Thyroid carcinoma.] [https://pubmed.ncbi.nlm.nih.gov/21081783/ PubMed]
 +
**'''2007:''' Sherman et al. [https://doi.org/10.6004/Jnccn.2007.0052 Thyroid carcinoma.] [https://pubmed.ncbi.nlm.nih.gov/17623612/ PubMed]
 +
**'''2005:''' Sherman et al. [https://doi.org/10.6004/Jnccn.2005.0021 Thyroid carcinoma.] [https://pubmed.ncbi.nlm.nih.gov/16002006/ PubMed]
  
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==[https://www.nccn.org/ NCCN]==
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=Advanced or metastatic disease=
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*[https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf NCCN Guidelines - Thyroid Carcinoma]
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==Axitinib monotherapy {{#subobject:73fcb6|Regimen=1}}==
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<div class="toccolours" style="background-color:#eeeeee">
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=Differentiated thyroid cancer, all lines of therapy=
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===Regimen {{#subobject:aff447|Variant=1}}===
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==Lenvatinib monotherapy {{#subobject:PYR1|Regimen=1}}==
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{| class="wikitable sortable" style="width: 60%; text-align:center;"  
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{| class="wikitable" style="float:right; margin-left: 5px;"
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!style="width: 33%"|Study
 +
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
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|[[#top|back to top]]
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|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859206/ Cohen et al. 2008 (A4061014)]
−
|}
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|Not reported
−
 
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| style="background-color:#91cf61" |Phase 2
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===Regimen {{#subobject:PYV1|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
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!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
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!Comparator
 
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![[Levels_of_Evidence#Efficacy|Efficacy]]
 
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|[http://www.nejm.org/doi/full/10.1056/NEJMoa1406470 Schlumberger et al. 2015 (SELECT)]
 
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| style="background-color:#1a9851" |Phase III
 
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|[[Thyroid_cancer#Placebo|Placebo]]
 
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| style="background-color:#1a9850" |Superior PFS
 
 
|-
 
|-
 
|}
 
|}
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====Chemotherapy====
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<div class="toccolours" style="background-color:#b3e2cd">
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*[[Lenvatinib (Lenvima)]] 24 mg PO once per day
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====Targeted therapy====
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**Per the package insert, patients with eGFR of less than 30 mL/min/1.73m<sup>2</sup> by Cockroft-Gault or Child-Pugh C severe hepatic impairment should receive 14 mg PO once per day
+
*[[Axitinib (Inlyta)]] 5 mg PO twice per day
−
 
+
'''Continued indefinitely'''
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'''28-day cycles'''
+
</div></div>
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===References===
 
===References===
−
<!-- # '''Abstract:''' Martin Schlumberger, Makoto Tahara, Lori J. Wirth, Bruce Robinson, Marcia S. Brose, Rossella Elisei, Corina E. Dutcus, Begoña de las Heras, Junming Zhu, Mouhammed Amir Habra, Kate Newbold, Manisha H. Shah, Ana O. Hoff, Andrew G Gianoukakis, Naomi Kiyota, Matthew Hiram Taylor, Sung-Bae Kim, Monika K Krzyzanowska, Steven I. Sherman. A phase 3, multicenter, double-blind, placebo-controlled trial of lenvatinib (E7080) in patients with 131I-refractory differentiated thyroid cancer (SELECT). 2014 ASCO Annual Meeting abstract LBA6008. [http://meetinglibrary.asco.org/content/132694-144 link to abstract] -->
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# '''A4061014:''' Cohen EE, Rosen LS, Vokes EE, Kies MS, Forastiere AA, Worden FP, Kane MA, Sherman E, Kim S, Bycott P, Tortorici M, Shalinsky DR, Liau KF, Cohen RB. Axitinib is an active treatment for all histologic subtypes of advanced thyroid cancer: results from a phase II study. J Clin Oncol. 2008 Oct 10;26(29):4708-13. Epub 2008 Jun 9. [https://doi.org/10.1200/jco.2007.15.9566 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859206/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/18541897/ PubMed] [https://clinicaltrials.gov/study/NCT00094055 NCT00094055]
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# Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. [http://www.nejm.org/doi/full/10.1056/NEJMoa1406470 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25671254 PubMed]
+
## '''Update:''' Cohen EE, Tortorici M, Kim S, Ingrosso A, Pithavala YK, Bycott P. A Phase II trial of axitinib in patients with various histologic subtypes of advanced thyroid cancer: long-term outcomes and pharmacokinetic/pharmacodynamic analyses. Cancer Chemother Pharmacol. 2014 Dec;74(6):1261-70. Epub 2014 Oct 15. [https://doi.org/10.1007/s00280-014-2604-8 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236619/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25315258/ PubMed]
  
−
==Pazopanib monotherapy {{#subobject:4ee26c|Regimen=1}}==
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==Doxorubicin monotherapy {{#subobject:41edd3|Regimen=1}}==
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{| class="wikitable" style="float:right; margin-left: 5px;"
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<div class="toccolours" style="background-color:#ee6b6e">
 +
===Regimen {{#subobject:1efbde|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
 +
!style="width: 33%"|Study
 +
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
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|[[#top|back to top]]
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|[https://doi.org/10.1056/NEJM197401242900404 Gottlieb et al. 1974]
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|}
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|1971-01 to 1973-06
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−
===Regimen {{#subobject:8faae3|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
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!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107731/ Bible et al. 2010]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Pazopanib (Votrient)]] 800 mg PO once per day
 
−
 
 
−
'''28-day cycles'''
 
−
 
 
−
===References===
 
−
# Bible KC, Suman VJ, Molina JR, Smallridge RC, Maples WJ, Menefee ME, Rubin J, Sideras K, Morris JC 3rd, McIver B, Burton JK, Webster KP, Bieber C, Traynor AM,  Flynn PJ, Goh BC, Tang H, Ivy SP, Erlichman C; Endocrine Malignancies Disease Oriented Group; Mayo Clinic Cancer Center; Mayo Phase 2 Consortium. Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study. Lancet Oncol. 2010 Oct;11(10):962-72. Epub 2010 Sep 17.  '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107731/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20851682 PubMed]
 
−
 
 
−
==Placebo==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#top|back to top]]
 
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|}
 
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===Regimen===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70335-2/fulltext Leboulleux et al. 2012]
 
−
| style="background-color:#1a9851" |Randomized Phase II (C)
 
−
|[[#Vandetanib_monotherapy|Vandetanib]]
 
−
| style="background-color:#d73027" |Inferior PFS
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366116/ Brose et al. 2014 (DECISION)]
 
−
| style="background-color:#1a9851" |Phase III (C)
 
−
|[[#Sorafenib_monotherapy|Sorafenib]]
 
−
| style="background-color:#d73027" |Inferior PFS
 
−
|-
 
−
|[http://www.nejm.org/doi/full/10.1056/NEJMoa1406470 Schlumberger et al. 2015 (SELECT)]
 
−
| style="background-color:#1a9851" |Phase III (C)
 
−
|[[Thyroid_cancer#Lenvatinib_monotherapy|Lenvatinib]]
 
−
| style="background-color:#d73027" |Inferior PFS
 
−
|-
 
−
|}
 
−
 
 
−
''No active antineoplastic treatment.''
 
−
 
 
−
===References===
 
−
# Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70335-2/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22898678 PubMed]
 
−
# Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ; DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014 Jul 26;384(9940):319-28. Epub 2014 Apr 24.  [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366116/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24768112 PubMed]
 
−
<!-- # '''Abstract:''' Martin Schlumberger, Makoto Tahara, Lori J. Wirth, Bruce Robinson, Marcia S. Brose, Rossella Elisei, Corina E. Dutcus, Begoña de las Heras, Junming Zhu, Mouhammed Amir Habra, Kate Newbold, Manisha H. Shah, Ana O. Hoff, Andrew G Gianoukakis, Naomi Kiyota, Matthew Hiram Taylor, Sung-Bae Kim, Monika K Krzyzanowska, Steven I. Sherman. A phase 3, multicenter, double-blind, placebo-controlled trial of lenvatinib (E7080) in patients with 131I-refractory differentiated thyroid cancer (SELECT). 2014 ASCO Annual Meeting abstract LBA6008. [http://meetinglibrary.asco.org/content/132694-144 link to abstract] -->
 
−
# Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. [http://www.nejm.org/doi/full/10.1056/NEJMoa1406470 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/25671254 PubMed]
 
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==Radioiodine ablation==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#top|back to top]]
 
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|}
 
−
 
 
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===Regimen===
 
−
To be completed
 
−
 
 
−
===References===
 
−
# Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, Bardet S, Leenhardt L, Bastie D, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Bonichon F, Dejax C, Toubert ME, Leboulleux S, Ricard M, Benhamou E; Tumeurs de la Thyroïde Refractaires Network for the Essai Stimulation Ablation Equivalence Trial. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med. 2012 May 3;366(18):1663-73. [http://www.nejm.org/doi/full/10.1056/NEJMoa1108586 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/22551127 PubMed]
 
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# Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, Nicol A, Clark PM, Farnell K, McCready R, Smellie J, Franklyn JA, John R, Nutting CM, Newbold K, Lemon C, Gerrard G, Abdel-Hamid A, Hardman J, Macias E, Roques T, Whitaker S, Vijayan R, Alvarez P, Beare S, Forsyth S, Kadalayil L, Hackshaw A. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med. 2012 May 3;366(18):1674-85. [http://www.nejm.org/doi/full/10.1056/NEJMoa1109589 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/22551128 PubMed]
 
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==Sorafenib monotherapy {{#subobject:36a6b4|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#top|back to top]]
 
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|}
 
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===Regimen {{#subobject:237686|Variant=1}}===
 
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{| class="wikitable" style="width: 100%; text-align:center;"
 
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!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
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!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366116/ Brose et al. 2014 (DECISION)]
 
−
| style="background-color:#1a9851" |Phase III (E)
 
−
|[[#Placebo|Placebo]]
 
−
| style="background-color:#1a9850" |Superior PFS
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Sorafenib (Nexavar)]] 400 mg PO BID
 
−
 
 
−
===References===
 
−
# Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ; DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014 Jul 26;384(9940):319-28. Epub 2014 Apr 24.  '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366116/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24768112 PubMed]
 
−
 
 
−
==Vandetanib monotherapy {{#subobject:83e502|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:d2f77d|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|[http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70335-2/fulltext Leboulleux et al. 2012]
 
−
| style="background-color:#1a9851" |Randomized Phase II (E)
 
−
|[[#Placebo|Placebo]]
 
−
| style="background-color:#1a9850" |Superior PFS
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Vandetanib (Caprelsa)]] 300 mg PO once per day
 
−
 
 
−
'''Continued until progression or intolerance'''
 
−
 
 
−
===References===
 
−
# Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. [http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70335-2/fulltext link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/22898678 PubMed]
 
−
 
 
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=Medullary thyroid cancer, all lines of therapy=
 
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==Cabozantinib monotherapy {{#subobject:1d67e4|Regimen=1}}==
 
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{| class="wikitable" style="float:right; margin-left: 5px;"
 
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|-
 
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|[[#top|back to top]]
 
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|}
 
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===Regimen {{#subobject:d4c2dd|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
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!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
!Comparator
 
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![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
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|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646303/ Kurzrock et al. 2011]
 
 
| style="background-color:#91cf61" |Non-randomized
 
| style="background-color:#91cf61" |Non-randomized
−
| style="background-color:#d3d3d3" |
 
−
| style="background-color:#d3d3d3" |
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164813/ Elisei et al. 2013 (EXAM)]
 
−
| style="background-color:#1a9851" |Phase III (E)
 
−
|[[#Placebo_2|Placebo]]
 
−
| style="background-color:#1a9850" |Superior PFS
 
 
|-
 
|-
 
|}
 
|}
 +
''Note: This is of historic interest.''
 +
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Cabozantinib (Cometriq)]] 140 mg PO once per day, at least 2 hours before or 1 hour after meals
+
*[[Doxorubicin (Adriamycin)]]
−
 
+
</div></div>
 
===References===
 
===References===
−
# Kurzrock R, Sherman SI, Ball DW, Forastiere AA, Cohen RB, Mehra R, Pfister DG, Cohen EE, Janisch L, Nauling F, Hong DS, Ng CS, Ye L, Gagel RF, Frye J, Müller T, Ratain MJ, Salgia R. Activity of XL184 (Cabozantinib), an oral tyrosine kinase inhibitor, in patients with medullary thyroid cancer. J Clin Oncol. 2011 Jul 1;29(19):2660-6. Epub 2011 May 23. [http://jco.ascopubs.org/content/29/19/2660.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646303/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/21606412 PubMed]
+
# Gottlieb JA, Hill CS Jr. Chemotherapy of thyroid cancer with adriamycin: experience with 30 patients. N Engl J Med. 1974 Jan 24;290(4):193-7. [https://doi.org/10.1056/NEJM197401242900404 link to original article] [https://pubmed.ncbi.nlm.nih.gov/4808917/ PubMed]
−
# '''EXAM:''' Elisei R, Schlumberger MJ, Müller SP, Schöffski P, Brose MS, Shah MH, Licitra L, Jarzab B, Medvedev V, Kreissl MC, Niederle B, Cohen EE, Wirth LJ, Ali H, Hessel C, Yaron Y, Ball D, Nelkin B, Sherman SI. Cabozantinib in progressive medullary thyroid cancer. J Clin Oncol. 2013 Oct 10;31(29):3639-46. Epub 2013 Sep 3. Erratum in: J Clin Oncol. 2014 Jun 10;32(17):1864. [http://jco.ascopubs.org/content/31/29/3639.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164813/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24002501 PubMed]
 
−
## '''Update:''' Schlumberger M, Elisei R, Müller S, Schöffski P, Brose M, Shah M, Licitra L, Krajewska J, Kreissl MC, Niederle B, Cohen EEW, Wirth L, Ali H, Clary DO, Yaron Y, Mangeshkar M, Ball D, Nelkin B, Sherman S. Overall survival analysis of EXAM, a phase III trial of cabozantinib in patients with radiographically progressive medullary thyroid carcinoma. Ann Oncol. 2017 Nov 1;28(11):2813-2819. [https://academic.oup.com/annonc/article/28/11/2813/4209987 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/29045520 PubMed]
 
−
 
 
−
==Placebo==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
 
 
−
===Regimen===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675689/ Wells et al. 2011]
 
−
| style="background-color:#1a9851" |Phase III (C)
 
−
|[[#Vandetanib_monotherapy_2|Vandetanib]]
 
−
| style="background-color:#d73027" |Inferior PFS
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164813/ Elisei et al. 2013]
 
−
| style="background-color:#1a9851" |Phase III (C)
 
−
|[[#Cabozantinib_monotherapy|Cabozantinib]]
 
−
| style="background-color:#d73027" |Inferior PFS
 
−
|-
 
−
|}
 
−
 
 
−
''No active antineoplastic treatment. Included for reference purposes only.''
 
−
 
 
−
===References===
 
−
# Wells SA Jr, Robinson BG, Gagel RF, Dralle H, Fagin JA, Santoro M, Baudin E, Elisei R, Jarzab B, Vasselli JR, Read J, Langmuir P, Ryan AJ, Schlumberger MJ. Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol. 2012 Jan 10;30(2):134-41. Epub 2011 Oct 24. [http://jco.ascopubs.org/content/30/2/134.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675689/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/22025146 PubMed]
 
−
# Elisei R, Schlumberger MJ, Müller SP, Schöffski P, Brose MS, Shah MH, Licitra L, Jarzab B, Medvedev V, Kreissl MC, Niederle B, Cohen EE, Wirth LJ, Ali H, Hessel C, Yaron Y, Ball D, Nelkin B, Sherman SI. Cabozantinib in progressive medullary thyroid cancer. J Clin Oncol. 2013 Oct 10;31(29):3639-46. Epub 2013 Sep 3. Erratum in: J Clin Oncol. 2014 Jun 10;32(17):1864. [http://jco.ascopubs.org/content/31/29/3639.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164813/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/24002501 PubMed]
 
−
 
 
−
==Sorafenib monotherapy {{#subobject:7e7480|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:1e2f21|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881718/ Lam et al. 2010]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Sorafenib (Nexavar)]] 400 mg PO BID
 
−
 
 
−
===References===
 
−
# Lam ET, Ringel MD, Kloos RT, Prior TW, Knopp MV, Liang J, Sammet S, Hall NC, Wakely PE Jr, Vasko VV, Saji M, Snyder PJ, Wei L, Arbogast D, Collamore M, Wright JJ, Moley JF, Villalona-Calero MA, Shah MH. Phase II clinical trial of sorafenib in metastatic medullary thyroid cancer. J Clin Oncol. 2010 May 10;28(14):2323-30. Epub 2010 Apr 5. [http://jco.ascopubs.org/content/28/14/2323.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881718/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20368568 PubMed]
 
−
 
 
−
==Sunitinib monotherapy {{#subobject:59fa83|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:7e9b73|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063514/ Carr et al. 2010]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Sunitinib (Sutent)]] 37.5 mg PO once per day
 
−
 
 
−
===References===
 
−
# Carr LL, Mankoff DA, Goulart BH, Eaton KD, Capell PT, Kell EM, Bauman JE, Martins RG. Phase II study of daily sunitinib in FDG-PET-positive, iodine-refractory differentiated thyroid cancer and metastatic medullary carcinoma of the thyroid with functional imaging correlation. Clin Cancer Res. 2010 Nov 1;16(21):5260-8. Epub 2010 Sep 16. [http://clincancerres.aacrjournals.org/content/16/21/5260.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063514/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20847059 PubMed]
 
−
 
 
−
==Vandetanib monotherapy {{#subobject:a85524|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Variant #1, 100 mg/d {{#subobject:148745|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902067/ Robinson et al. 2010]
 
−
| style="background-color:#ffffbe" |Phase II, <20 patients
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Vandetanib (Caprelsa)]] 100 mg PO once per day
 
−
 
 
−
'''Continued until progression or intolerance'''
 
−
 
 
−
''At progression, eligible patients could increase the dose to 300 mg PO once per day; see paper for details.''
 
−
 
 
−
===Variant #2, 300 mg/d {{#subobject:e75f4f|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
!Comparator
 
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834392/ Wells et al. 2010]
 
−
| style="background-color:#91cf61" |Phase II
 
−
| style="background-color:#d3d3d3" |
 
−
| style="background-color:#d3d3d3" |
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675689/ Wells et al. 2011]
 
−
| style="background-color:#1a9851" |Phase III (E)
 
−
|[[Thyroid_cancer#Placebo_2|Placebo]]
 
−
| style="background-color:#1a9850" |Superior PFS
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Vandetanib (Caprelsa)]] 300 mg PO once per day
 
−
 
 
−
'''Continued indefinitely'''
 
−
 
 
−
===References===
 
−
# Wells SA Jr, Gosnell JE, Gagel RF, Moley J, Pfister D, Sosa JA, Skinner M, Krebs A, Vasselli J, Schlumberger M. Vandetanib for the treatment of patients with locally advanced or metastatic hereditary medullary thyroid cancer. J Clin Oncol. 2010 Feb 10;28(5):767-72. Epub 2010 Jan 11. [http://jco.ascopubs.org/content/28/5/767.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834392/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20065189 PubMed]
 
−
# Robinson BG, Paz-Ares L, Krebs A, Vasselli J, Haddad R. Vandetanib (100 mg) in patients with locally advanced or metastatic hereditary medullary thyroid cancer. J Clin Endocrinol Metab. 2010 Jun;95(6):2664-71. Epub 2010 Apr 6. [http://jcem.endojournals.org/content/95/6/2664.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902067/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20371662 PubMed] content property of [http://hemonc.org HemOnc.org]
 
−
# Wells SA Jr, Robinson BG, Gagel RF, Dralle H, Fagin JA, Santoro M, Baudin E, Elisei R, Jarzab B, Vasselli JR, Read J, Langmuir P, Ryan AJ, Schlumberger MJ. Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, double-blind phase III trial. J Clin Oncol. 2012 Jan 10;30(2):134-41. Epub 2011 Oct 24. [http://jco.ascopubs.org/content/30/2/134.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675689/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/22025146 PubMed]
 
−
 
 
−
=Various histologies, advanced or metastatic disease=
 
−
==Axitinib monotherapy {{#subobject:73fcb6|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:aff447|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859206/ Cohen et al. 2008]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|-
 
−
|[http://onlinelibrary.wiley.com/doi/10.1002/cncr.28766/full Locati et al. 2014]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Axitinib (Inlyta)]] 5 mg PO BID
 
−
 
 
−
===References===
 
−
# Cohen EE, Rosen LS, Vokes EE, Kies MS, Forastiere AA, Worden FP, Kane MA, Sherman E, Kim S, Bycott P, Tortorici M, Shalinsky DR, Liau KF, Cohen RB. Axitinib is an active treatment for all histologic subtypes of advanced thyroid cancer: results from a phase II study. J Clin Oncol. 2008 Oct 10;26(29):4708-13. Epub 2008 Jun 9. [http://jco.ascopubs.org/content/26/29/4708.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859206/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/18541897 PubMed]
 
−
## '''Update:''' Cohen EE, Tortorici M, Kim S, Ingrosso A, Pithavala YK, Bycott P. A Phase II trial of axitinib in patients with various histologic subtypes of advanced thyroid cancer: long-term outcomes and pharmacokinetic/pharmacodynamic analyses. Cancer Chemother Pharmacol. 2014 Dec;74(6):1261-70. Epub 2014 Oct 15.  [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236619/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/25315258 PubMed]
 
−
# Locati LD, Licitra L, Agate L, Ou SH, Boucher A, Jarzab B, Qin S, Kane MA, Wirth LJ, Chen C, Kim S, Ingrosso A, Pithavala YK, Bycott P, Cohen EE. Treatment of advanced thyroid cancer with axitinib: Phase 2 study with pharmacokinetic/pharmacodynamic and quality-of-life assessments. Cancer. 2014 Sep 1;120(17):2694-703. Epub 2014 May 20. [http://onlinelibrary.wiley.com/doi/10.1002/cncr.28766/full link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/24844950 PubMed]
 
  
 
==Sorafenib monotherapy {{#subobject:31cae2|Regimen=1}}==
 
==Sorafenib monotherapy {{#subobject:31cae2|Regimen=1}}==
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
<div class="toccolours" style="background-color:#eeeeee">
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
 
===Regimen {{#subobject:e09f77|Variant=1}}===
 
===Regimen {{#subobject:e09f77|Variant=1}}===
−
{| class="wikitable" style="width: 100%; text-align:center;"  
+
{| class="wikitable sortable" style="width: 80%; text-align:center;"  
−
!Study
+
!style="width: 25%"|Study
−
![[Levels_of_Evidence#Evidence|Evidence]]
+
!style="width: 25%"|Dates of enrollment
−
![[Levels_of_Evidence#Efficacy|Efficacy]]
+
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
 
|-
 
|-
 
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653134/ Gupta-Abramson et al. 2008]
 
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653134/ Gupta-Abramson et al. 2008]
−
| style="background-color:#91cf61" |Phase II
+
|2006-02-28 to 2007-09-13
 +
| style="background-color:#91cf61" |Phase 2
 
|ORR: 23% (95% CI, 10-42)
 
|ORR: 23% (95% CI, 10-42)
 
|-
 
|-
 
|}
 
|}
−
====Chemotherapy====
+
<div class="toccolours" style="background-color:#b3e2cd">
−
*[[Sorafenib (Nexavar)]] 400 mg PO BID
+
====Targeted therapy====
−
 
+
*[[Sorafenib (Nexavar)]] 400 mg PO twice per day on days 1 to 28
−
'''Continuously'''
+
'''28-day cycles'''
−
 
+
</div></div>
−
===References===
 
−
# Gupta-Abramson V, Troxel AB, Nellore A, Puttaswamy K, Redlinger M, Ransone K, Mandel SJ, Flaherty KT, Loevner LA, O'Dwyer PJ, Brose MS. Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol. 2008 Oct 10;26(29):4714-9. Epub 2008 Jun 9. [http://jco.ascopubs.org/content/26/29/4714.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653134/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/18541894 PubMed]
 
−
 
 
−
==Sunitinib monotherapy {{#subobject:8d6c5|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
===Regimen {{#subobject:d1cea4|Variant=1}}===
 
−
{| class="wikitable" style="width: 100%; text-align:center;"  
 
−
!Study
 
−
![[Levels_of_Evidence#Evidence|Evidence]]
 
−
|'''ORR'''
 
−
|-
 
−
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063514/ Carr et al. 2010]
 
−
| style="background-color:#91cf61" |Phase II
 
−
|31% (95% CI: 16-47)
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Sunitinib (Sutent)]] 37.5 mg PO once per day
 
−
 
 
 
===References===
 
===References===
−
# Carr LL, Mankoff DA, Goulart BH, Eaton KD, Capell PT, Kell EM, Bauman JE, Martins RG. Phase II study of daily sunitinib in FDG-PET-positive, iodine-refractory differentiated thyroid cancer and metastatic medullary carcinoma of the thyroid with functional imaging correlation. Clin Cancer Res. 2010 Nov 1;16(21):5260-8. Epub 2010 Sep 16. [http://clincancerres.aacrjournals.org/content/16/21/5260.long link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063514/ link to PMC article] [https://www.ncbi.nlm.nih.gov/pubmed/20847059 PubMed]
+
# Gupta-Abramson V, Troxel AB, Nellore A, Puttaswamy K, Redlinger M, Ransone K, Mandel SJ, Flaherty KT, Loevner LA, O'Dwyer PJ, Brose MS. Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol. 2008 Oct 10;26(29):4714-9. Epub 2008 Jun 9. [https://doi.org/10.1200/jco.2008.16.3279 link to original article] '''dosing details in manuscript have been reviewed by our editors''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653134/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/18541894/ PubMed]
−
 
 
 
[[Category:Thyroid cancer regimens]]
 
[[Category:Thyroid cancer regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
 
[[Category:Endocrine cancers]]
 
[[Category:Endocrine cancers]]
 
[[Category:Head and neck cancers]]
 
[[Category:Head and neck cancers]]

Latest revision as of 12:20, 15 July 2024

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Section editor
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If you are interested in this role, please contact us at [email protected].

Note: most thyroid cancer regimens can be found on dedicated pages:

3 regimens on this page
3 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

ATA

  • 2015: Guidelines on the management of thyroid nodules and differentiated thyroid cancer PubMed
  • 2015: Guidelines for the management of medullary thyroid carcinoma PubMed
  • 2012: Guidelines for management of patients with anaplastic thyroid cancer PubMed

ESMO

NCCN

Advanced or metastatic disease

Axitinib monotherapy

Regimen

Study Dates of enrollment Evidence
Cohen et al. 2008 (A4061014) Not reported Phase 2

Targeted therapy

Continued indefinitely

References

  1. A4061014: Cohen EE, Rosen LS, Vokes EE, Kies MS, Forastiere AA, Worden FP, Kane MA, Sherman E, Kim S, Bycott P, Tortorici M, Shalinsky DR, Liau KF, Cohen RB. Axitinib is an active treatment for all histologic subtypes of advanced thyroid cancer: results from a phase II study. J Clin Oncol. 2008 Oct 10;26(29):4708-13. Epub 2008 Jun 9. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00094055
    1. Update: Cohen EE, Tortorici M, Kim S, Ingrosso A, Pithavala YK, Bycott P. A Phase II trial of axitinib in patients with various histologic subtypes of advanced thyroid cancer: long-term outcomes and pharmacokinetic/pharmacodynamic analyses. Cancer Chemother Pharmacol. 2014 Dec;74(6):1261-70. Epub 2014 Oct 15. link to original article link to PMC article PubMed

Doxorubicin monotherapy

Regimen

Study Dates of enrollment Evidence
Gottlieb et al. 1974 1971-01 to 1973-06 Non-randomized

Note: This is of historic interest.

Chemotherapy

References

  1. Gottlieb JA, Hill CS Jr. Chemotherapy of thyroid cancer with adriamycin: experience with 30 patients. N Engl J Med. 1974 Jan 24;290(4):193-7. link to original article PubMed

Sorafenib monotherapy

Regimen

Study Dates of enrollment Evidence Efficacy
Gupta-Abramson et al. 2008 2006-02-28 to 2007-09-13 Phase 2 ORR: 23% (95% CI, 10-42)

Targeted therapy

28-day cycles

References

  1. Gupta-Abramson V, Troxel AB, Nellore A, Puttaswamy K, Redlinger M, Ransone K, Mandel SJ, Flaherty KT, Loevner LA, O'Dwyer PJ, Brose MS. Phase II trial of sorafenib in advanced thyroid cancer. J Clin Oncol. 2008 Oct 10;26(29):4714-9. Epub 2008 Jun 9. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
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