Follicular thyroid cancer medical therapy: Difference between revisions
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{{CMG}}; {{AE}} {{Ammu}} | {{CMG}}; {{AE}} {{Ammu}} | ||
==Overview== | ==Overview== | ||
Pharmacologic medical therapies for follicular thyroid cancer include [[radioactive]] [[iodine]] therapy and targeted medical therapy. | |||
==Medical Therapy== | ==Medical Therapy== | ||
===Thyroid Hormone Replacement=== | ===Thyroid Hormone Replacement=== | ||
* Thyroxine is recommended as a replacement therapy for all patients with follicular thyroid | * [[Thyroxine]] is recommended as a replacement therapy for all [[patients]] with follicular thyroid cancer especially for micronodular [[pulmonary]] [[metastases]].<ref name="McHenryPhitayakorn2011">{{cite journal|last1=McHenry|first1=C. R.|last2=Phitayakorn|first2=R.|title=Follicular Adenoma and Carcinoma of the Thyroid Gland|journal=The Oncologist|volume=16|issue=5|year=2011|pages=585–593|issn=1083-7159|doi=10.1634/theoncologist.2010-0405}}</ref> | ||
===Radioactive Iodine Therapy=== | ===Radioactive Iodine Therapy=== | ||
* | * [[Radioactive]] [[iodine]] ablation therapy may be used to prevent the recurrence of [[cancer]]. | ||
* High doses of [[radioiodine]] is also used to treat microscopic [[bone]] [[metastasis]]. | |||
===Targeted Therapy=== | ===Targeted Therapy=== | ||
==== | * This type of treatment is done using:<ref name="pmid23185034">{{cite journal |vauthors=Carhill AA, Cabanillas ME, Jimenez C, Waguespack SG, Habra MA, Hu M, Ying A, Vassilopoulou-Sellin R, Gagel RF, Sherman SI, Busaidy NL |title=The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring |journal=J. Clin. Endocrinol. Metab. |volume=98 |issue=1 |pages=31–42 |date=January 2013 |pmid=23185034 |pmc=3537108 |doi=10.1210/jc.2012-2909 |url=}}</ref><ref name="pmid22007339">{{cite journal |vauthors=Cabanillas ME, Hu MI, Durand JB, Busaidy NL |title=Challenges associated with tyrosine kinase inhibitor therapy for metastatic thyroid cancer |journal=J Thyroid Res |volume=2011 |issue= |pages=985780 |date=2011 |pmid=22007339 |pmc=3189619 |doi=10.4061/2011/985780 |url=}}</ref> | ||
* Sorafenib | ** [[Sorafenib]], is an orally active, multityrosine kinase inhibitor. | ||
* Lenvatinib | ** [[Lenvatinib]], an orally active, multitargeted [[tyrosine kinase]] inhibitor.<ref name="pmid25671254">{{cite journal |vauthors=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 |title=Lenvatinib versus placebo in radioiodine-refractory thyroid cancer |journal=N. Engl. J. Med. |volume=372 |issue=7 |pages=621–30 |date=February 2015 |pmid=25671254 |doi=10.1056/NEJMoa1406470 |url=}}</ref> | ||
'''Adult''' | |||
* Preferred regimen: [[Lenvatinib]] 24 mg PO daily until [[disease]] progression or unacceptable [[toxicity]]. | |||
* Alternative regimen: [[Sorefenib]] 400 mg PO q12h until [[disease]] progression or unacceptable [[toxicity]]. | |||
* Alternative regimen: [[Larotrectinib]] 100 mg PO q12h until [[disease]] progression or unacceptable [[toxicity]]. | |||
* Alternative regimen: [[Entrectinib]] 600 mg PO daily until [[disease]] progression or unacceptable [[toxicity]]. | |||
===Radiation Therapy=== | |||
* External radiation therapy is used for bone pain in bone metastasis. | |||
===Other Treatment Options=== | |||
* [[Intravenous]] infusions of bisphosphonate is also used to reduce pain in [[bone]] [[metastasis]]. | |||
* [[Corticosteroid]] therapy is recommended for [[cerebral edema]] secondary to [[brain]] [[metastasis]]. | |||
===Treatment Options for Follicular Thyroid Cancer=== | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | A01 | | | | | | | | |A01=Follicular thyroid cnacer treatment}} | |||
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }} | |||
{{familytree | | B01 | | | | | B02 | | | | | B03 |B01=Localized or regional [[tumor]]|B02=[[Metastatic]]|B03=Recurrent}} | |||
{{familytree | | |!| | | | | | |!| | | | | | |!| | }} | |||
{{familytree | | C01 | | | | | |!| | | | | | C03 |C01=[[Surgery]]<br>Total [[thyroidectomy]]<br>Lobectomy<br>[[Radioactive iodine uptake|RAI therapy]]<br>Thyroid suppression therapy<br>[[External beam radiation therapy|EBRT]]|C03=[[Surgery]] ± postoperative [[Radioactive iodine uptake|RAI therapy]]<br>Targeted therapy<br>[[External beam radiation therapy|EBRT]]<br>[[Chemotherapy]]}} | |||
{{familytree | | | | | | |,|-|-|^|-|-|.| | }} | |||
{{familytree | | | | | | D01 | | | | D03 | |D01=Iodine sensitive|D03=Iodine resistent}} | |||
{{familytree | | | | | | |!| | | | | |!| | |}} | |||
{{familytree | | | | | | E01 | | | | E02 | |E01=[[Radioactive iodine uptake|RAI therapy]]<br>Thyroid suppression therapy|E02=Thyroid suppression therapy<br>Targeted therapy<br>Surgery<br>[[External beam radiation therapy|EBRT]]}} | |||
{| | |||
! colspan="2" style="background:#DCDCDC;" align="center" + | | |||
|- | |||
|} | |||
==Reference== | |||
{{Reflist|2}} | |||
[[Category:Endocrine system]] | |||
[[Category:Endocrinology]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Disease]] | |||
[[Category:Genetic disorders]] | |||
[[Category:Types of cancer]] | |||
[[Category:Hereditary cancers]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 13:43, 29 October 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Pharmacologic medical therapies for follicular thyroid cancer include radioactive iodine therapy and targeted medical therapy.
Medical Therapy
Thyroid Hormone Replacement
- Thyroxine is recommended as a replacement therapy for all patients with follicular thyroid cancer especially for micronodular pulmonary metastases.[1]
Radioactive Iodine Therapy
- Radioactive iodine ablation therapy may be used to prevent the recurrence of cancer.
- High doses of radioiodine is also used to treat microscopic bone metastasis.
Targeted Therapy
- This type of treatment is done using:[2][3]
- Sorafenib, is an orally active, multityrosine kinase inhibitor.
- Lenvatinib, an orally active, multitargeted tyrosine kinase inhibitor.[4]
Adult
- Preferred regimen: Lenvatinib 24 mg PO daily until disease progression or unacceptable toxicity.
- Alternative regimen: Sorefenib 400 mg PO q12h until disease progression or unacceptable toxicity.
- Alternative regimen: Larotrectinib 100 mg PO q12h until disease progression or unacceptable toxicity.
- Alternative regimen: Entrectinib 600 mg PO daily until disease progression or unacceptable toxicity.
Radiation Therapy
- External radiation therapy is used for bone pain in bone metastasis.
Other Treatment Options
- Intravenous infusions of bisphosphonate is also used to reduce pain in bone metastasis.
- Corticosteroid therapy is recommended for cerebral edema secondary to brain metastasis.
Treatment Options for Follicular Thyroid Cancer
| Follicular thyroid cnacer treatment | |||||||||||||||||||||||||||||||||||||
| Localized or regional tumor | Metastatic | Recurrent | |||||||||||||||||||||||||||||||||||
| Surgery Total thyroidectomy Lobectomy RAI therapy Thyroid suppression therapy EBRT | Surgery ± postoperative RAI therapy Targeted therapy EBRT Chemotherapy | ||||||||||||||||||||||||||||||||||||
| Iodine sensitive | Iodine resistent | ||||||||||||||||||||||||||||||||||||
| RAI therapy Thyroid suppression therapy | Thyroid suppression therapy Targeted therapy Surgery EBRT | ||||||||||||||||||||||||||||||||||||
Reference
- ↑ McHenry, C. R.; Phitayakorn, R. (2011). "Follicular Adenoma and Carcinoma of the Thyroid Gland". The Oncologist. 16 (5): 585–593. doi:10.1634/theoncologist.2010-0405. ISSN 1083-7159.
- ↑ Carhill AA, Cabanillas ME, Jimenez C, Waguespack SG, Habra MA, Hu M, Ying A, Vassilopoulou-Sellin R, Gagel RF, Sherman SI, Busaidy NL (January 2013). "The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring". J. Clin. Endocrinol. Metab. 98 (1): 31–42. doi:10.1210/jc.2012-2909. PMC 3537108. PMID 23185034.
- ↑ Cabanillas ME, Hu MI, Durand JB, Busaidy NL (2011). "Challenges associated with tyrosine kinase inhibitor therapy for metastatic thyroid cancer". J Thyroid Res. 2011: 985780. doi:10.4061/2011/985780. PMC 3189619. PMID 22007339.
- ↑ 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 (February 2015). "Lenvatinib versus placebo in radioiodine-refractory thyroid cancer". N. Engl. J. Med. 372 (7): 621–30. doi:10.1056/NEJMoa1406470. PMID 25671254.