Medullary thyroid cancer medical therapy: Difference between revisions
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===Protein kinase inhibitors=== | ===Protein kinase inhibitors=== | ||
* [[Vandetanib]], trade name Caprelsa, was the first drug (April 2011) to be approved by US [[Food and Drug Administration]] (FDA) for treatment of late-stage (metastatic) medullary thyroid cancer in adult patients who are ineligible for surgery.<ref>{{cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm250168.htm|title=FDA approves new treatment for rare form of thyroid cancer|accessdate=7 April 2011}}</ref> | * [[Vandetanib]], trade name Caprelsa, was the first drug (April 2011) to be approved by US [[Food and Drug Administration]] (FDA) for treatment of late-stage (metastatic) medullary thyroid cancer in adult patients who are ineligible for surgery.<ref>{{cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm250168.htm|title=FDA approves new treatment for rare form of thyroid cancer|accessdate=7 April 2011}}</ref> | ||
* [[Cabozantinib]], was granted marketing approval (November 2012) by the U.S. FDA for this indication.<ref>{{cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm330143.htm|title=FDA approves Cometriq to treat rare type of thyroid cancer|accessdate= 29 November 2012}}</ref> Cabozantinib which is a potent inhibitor of RET, MET and VEGF was evaluated in a double-blind placebo controlled trial. | * [[Cabozantinib]], was granted marketing approval (November 2012) by the U.S. FDA for this indication.<ref>{{cite web|url=http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm330143.htm|title=FDA approves Cometriq to treat rare type of thyroid cancer|accessdate= 29 November 2012}}</ref> Cabozantinib which is a potent inhibitor of ''RET'', ''MET'' and ''VEGF'' was evaluated in a double-blind placebo controlled trial. | ||
* Clinical trials of [[protein kinase inhibitor]]s,<ref name="titleAmerican Thyroid Association - Thyroid Clinical Trials">{{cite web |url=http://www.thyroidtrials.org |title=American Thyroid Association - Thyroid Clinical Trials |accessdate=2007-12-21 |format= |work=}}</ref> which block the abnormal kinase proteins involved in the development and growth of medullary cancer cells, showed clear evidence of response in 10-30% of patients. In the majority of responders there has been less than a 30% decrease in tumor mass, yet the responses have been durable; responses have been stable for periods exceeding 3 years. The major side effects of this class of drug include [[hypertension]], [[nausea]], [[diarrhea]], some cardiac electrical abnormalities, and thrombotic or bleeding episodes. | * Clinical trials of [[protein kinase inhibitor]]s,<ref name="titleAmerican Thyroid Association - Thyroid Clinical Trials">{{cite web |url=http://www.thyroidtrials.org |title=American Thyroid Association - Thyroid Clinical Trials |accessdate=2007-12-21 |format= |work=}}</ref> which block the abnormal kinase proteins involved in the development and growth of medullary cancer cells, showed clear evidence of response in 10-30% of patients. In the majority of responders there has been less than a 30% decrease in tumor mass, yet the responses have been durable; responses have been stable for periods exceeding 3 years. The major side effects of this class of drug include [[hypertension]], [[nausea]], [[diarrhea]], some cardiac electrical abnormalities, and thrombotic or bleeding episodes. | ||
===Radiation=== | ===Radiation=== | ||
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===Hormone Therapy=== | ===Hormone Therapy=== | ||
* [[Hormonal therapy]] is given to replace the thyroid hormones normally made by the [[thyroid gland]]. Thyroid stimulation hormone (TSH) suppression, brought on by thyroid hormone replacement, does not reduce the chance of medullary thyroid cancer recurrence like it does in papillary and follicular thyroid cancer. | * [[Hormonal therapy]] is given to replace the thyroid hormones normally made by the [[thyroid gland]]. Thyroid stimulation hormone (TSH) suppression, brought on by thyroid hormone replacement, does not reduce the chance of medullary thyroid cancer recurrence like it does in papillary and follicular thyroid cancer. | ||
==Reference== | ==Reference== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 19:30, 18 November 2015
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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
The predominant therapy for medullary thyroid cancer is surgical resection. Adjunctive chemoradiation may be required. The optimal therapy for medullary thyroid cancer depends on the stage at diagnosis.
Medical Therapy
Protein kinase inhibitors
- Vandetanib, trade name Caprelsa, was the first drug (April 2011) to be approved by US Food and Drug Administration (FDA) for treatment of late-stage (metastatic) medullary thyroid cancer in adult patients who are ineligible for surgery.[1]
- Cabozantinib, was granted marketing approval (November 2012) by the U.S. FDA for this indication.[2] Cabozantinib which is a potent inhibitor of RET, MET and VEGF was evaluated in a double-blind placebo controlled trial.
- Clinical trials of protein kinase inhibitors,[3] which block the abnormal kinase proteins involved in the development and growth of medullary cancer cells, showed clear evidence of response in 10-30% of patients. In the majority of responders there has been less than a 30% decrease in tumor mass, yet the responses have been durable; responses have been stable for periods exceeding 3 years. The major side effects of this class of drug include hypertension, nausea, diarrhea, some cardiac electrical abnormalities, and thrombotic or bleeding episodes.
Radiation
- External beam radiotherapy is recommended when there is a high risk of regional recurrence, even after optimum surgical treatment.
- Unlike other differentiated thyroid carcinoma, there is no role for radioiodine treatment in medullary-type disease.[4]
Hormone Therapy
- Hormonal therapy is given to replace the thyroid hormones normally made by the thyroid gland. Thyroid stimulation hormone (TSH) suppression, brought on by thyroid hormone replacement, does not reduce the chance of medullary thyroid cancer recurrence like it does in papillary and follicular thyroid cancer.
Reference
- ↑ "FDA approves new treatment for rare form of thyroid cancer". Retrieved 7 April 2011.
- ↑ "FDA approves Cometriq to treat rare type of thyroid cancer". Retrieved 29 November 2012.
- ↑ "American Thyroid Association - Thyroid Clinical Trials". Retrieved 2007-12-21.
- ↑ Quayle FJ, Moley JF (2005). "Medullary thyroid carcinoma: including MEN 2A and MEN 2B syndromes". J Surg Oncol. 89 (3): 122–9. doi:10.1002/jso.20184. PMID 15719378.