Difference between revisions of "Thyroid cancer"
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Revision as of 13:58, 23 January 2018
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Section editor | |
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Michael Gibson, MD, PhD Nashville, TN Twitter: mgibson21212 |
3 regimens on this page
3 variants on this page
|
Guidelines
ESMO
- Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. (2012) PubMed
NCCN
Differentiated thyroid cancer, all lines of therapy
Lenvatinib monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Schlumberger et al. 2015 (SELECT) | Phase III | Placebo | Superior PFS |
Chemotherapy
- Lenvatinib (Lenvima) 24 mg PO once per day
- Per the package insert, patients with eGFR of less than 30 mL/min/1.73m2 by Cockroft-Gault or Child-Pugh C severe hepatic impairment should receive 14 mg PO once per day
28-day cycles
References
- 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. link to original article PubMed
Pazopanib monotherapy
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Regimen
Study | Evidence |
---|---|
Bible et al. 2010 | 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 link to PMC article PubMed
Placebo
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Leboulleux et al. 2012 | Randomized Phase II (C) | Vandetanib | Inferior PFS |
Brose et al. 2014 (DECISION) | Phase III (C) | Sorafenib | Inferior PFS |
Schlumberger et al. 2015 (SELECT) | Phase III (C) | Lenvatinib | 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. link to original article contains protocol 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. link to PMC article PubMed
- 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. link to original article PubMed
Radioiodine ablation
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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. link to original article PubMed
- 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. link to original article PubMed
Sorafenib monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Brose et al. 2014 (DECISION) | Phase III (E) | Placebo | 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 link to PMC article PubMed
Vandetanib monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Leboulleux et al. 2012 | Randomized Phase II (E) | Placebo | 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. link to original article contains protocol PubMed
Vemurafenib monotherapy
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Regimen
Study | Evidence |
---|---|
Brose et al. 2016 | Phase II |
Note: this study was in patients with papillary thyroid cancer, only.
Chemotherapy
- Vemurafenib (Zelboraf) 960 mg PO BID
28-day cycles until progression or intolerable toxicity
References
- Brose MS, Cabanillas ME, Cohen EE, Wirth LJ, Riehl T, Yue H, Sherman SI, Sherman EJ. Vemurafenib in patients with BRAF(V600E)-positive metastatic or unresectable papillary thyroid cancer refractory to radioactive iodine: a non-randomised, multicentre, open-label, phase 2 trial. Lancet Oncol. 2016 Sep;17(9):1272-82. Epub 2016 Jul 23. link to original article contains verified protocol link to PMC article PubMed
Medullary thyroid cancer, all lines of therapy
Cabozantinib monotherapy
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Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Kurzrock et al. 2011 | Non-randomized | ||
Elisei et al. 2013 | Phase III (E) | Placebo | Superior PFS |
Chemotherapy
- Cabozantinib (Cometriq) 140 mg PO once per day, at least 2 hours before or 1 hour after meals
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. link to original article contains verified protocol link to PMC article 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. link to original article contains verified protocol link to PMC article PubMed
Placebo
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Wells et al. 2011 | Phase III (C) | Vandetanib | Inferior PFS |
Elisei et al. 2013 | Phase III (C) | Cabozantinib | 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. link to original article contains verified protocol link to PMC article 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. link to original article contains verified protocol link to PMC article PubMed
Sorafenib monotherapy
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Regimen
Study | Evidence |
---|---|
Lam et al. 2010 | 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. link to original article contains verified protocol link to PMC article PubMed
Sunitinib monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Carr et al. 2010 | 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. link to original article contains verified protocol link to PMC article PubMed
Vandetanib monotherapy
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Regimen #1
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Wells et al. 2010 | Phase II | ||
Wells et al. 2011 | Phase III (E) | Placebo | Superior PFS |
Chemotherapy
- Vandetanib (Caprelsa) 300 mg PO once per day
Continued until progression or intolerance
Regimen #2
Study | Evidence |
---|---|
Robinson et al. 2010 | 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.
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. link to original article contains verified protocol link to PMC article 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. link to original article contains verified protocol link to PMC article PubMed content property of 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. link to original article contains verified protocol link to PMC article PubMed
Various histologies, advanced or metastatic disease
Axitinib monotherapy
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Regimen
Study | Evidence |
---|---|
Cohen et al. 2008 | Phase II |
Locati et al. 2014 | 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. link to original article contains verified protocol link to PMC article 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. link to PMC article 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. link to original article contains verified protocol PubMed
Dabrafenib & Trametinib
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Regimen
Study | Evidence | Efficacy |
---|---|---|
Subbiah et al. 2017 | Phase II, <20 pts | ORR: 63% (95% CI, 35-85) |
Patients in this trial had previously treated anaplastic thyroid cancer with BRAF p.V600E mutation.
Chemotherapy
- Dabrafenib (Tafinlar) 150 mg PO BID
- Trametinib (Mekinist) 2 mg PO once per day
Continuously
References
- Subbiah V, Kreitman RJ, Wainberg ZA, Cho JY, Schellens JHM, Soria JC, Wen PY, Zielinski C, Cabanillas ME, Urbanowitz G, Mookerjee B, Wang D, Rangwala F, Keam B. Dabrafenib and trametinib treatment in patients with locally advanced or metastatic BRAF V600-mutant anaplastic thyroid cancer. J Clin Oncol. 2018 Jan 1;36(1):7-13. Epub 2017 Oct 26. link to original article contains verified protocol PubMed
Sorafenib monotherapy
back to top |
Regimen
Study | Evidence | Efficacy |
---|---|---|
Gupta-Abramson et al. 2008 | Phase II | ORR: 23% (95% CI, 10-42) |
Chemotherapy
- Sorafenib (Nexavar) 400 mg PO BID
Continuously
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. link to original article contains verified protocol link to PMC article PubMed
Sunitinib monotherapy
back to top |
Regimen
Study | Evidence | ORR |
---|---|---|
Carr et al. 2010 | Phase II | 31% (95% CI: 16-47) |
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. link to original article contains verified protocol link to PMC article PubMed