Avidity and outcomes of radioiodine therapy for distant metastasis of distinct types of differentiated thyroid cancer

2021 ◽  
Author(s):  
Joana Simões-Pereira ◽  
Nádia Mourinho ◽  
Teresa C. Ferreira ◽  
Edward Limbert ◽  
Branca Maria Cavaco ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factor ◽  
Metastatic Disease ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Therapy ◽  
Progression Free Survival ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Distant Metastatic Disease ◽  
Resection Status

Abstract Context The recommendations for radioiodine therapy (RAIT) in metastatic differentiated thyroid cancer (DTC) are mostly based in the experience with papillary histotype and do not consider the differences within the distinct types of DTC, in terms of RAIT uptake and response. Objective To investigate the association between histology and RAIT avidity and response; to evaluate whether histotype was an independent prognostic factor in progression-free survival (PFS) and disease-specific survival (DSS) after RAIT for distant metastatic disease. Design Retrospective analysis of all DTC patients submitted to RAIT due to distant metastatic disease, between 2001-2018. Setting Thyroid cancer referral centre. Patients We included 126 patients: 42 (33.3%) classical variant papillary thyroid cancer (cvPTC), 45 (35.7%) follicular variant PTC (fvPTC), 17 (13.5%) follicular thyroid cancer (FTC) and 22 (17.5%) Hürthle-cell carcinoma. Main outcome measures RAIT avidity and response. Results RAIT avidity was independently associated with histology (p<0.001) and stimulated thyroglobulin at first RAIT for distant lesions (p=0.007). Avidity was lowest in HCC (13.6%), intermediate in cvPTC (21.4%), and highest in fvPTC (75.6%) and FTC (76.5%). Regarding RAIT response, HCC and FTC were not different; both showed significantly more often progression after RAIT than fvPTC and cvPTC. Histology influenced PFS (p=0.014), but tumour type was not a significant prognostic factor in DSS. Instead, age at diagnosis, resection status, and stimulated thyroglobulin at the first RAIT were significantly associated with DSS. Conclusion DTC histotype influenced RAIT avidity and PFS. It is crucial to better detect the metastatic patients that may benefit the most from RAIT.

scholarly journals Efficacy and tolerability of lenvatinib in patients with radioiodine-refractory differentiated thyroid cancer: results of a multicenter observational study in the Russian Federation

2020 ◽  
Vol 10 (1) ◽  
pp. 65-72
Author(s):  
E. V. Borodavina ◽  
P. A. Isaev ◽  
A. Yu. Shurinov ◽  
P. O. Rumyantsev ◽  
V. V. Krylov ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Russian Federation ◽  
Differentiated Thyroid Cancer ◽  
Progression Free Survival ◽  
Good Tolerability ◽  
Study Objective ◽  
Free Survival ◽  
Median Progression Free Survival ◽  
The Russian Federation

Background. The implementation of tyrosine kinase inhibitors into clinical practice improved treatment outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RR-DTC). Lenvatinib is recommended as a first-line drug for these patients. The study objective is to analyze clinical experience with lenvatinib in patients with RR-DTC in the Russian Federation. Materials and methods. The data from 18 clinical sites in Russia was analyzed for the period December 2015 and September 2019. Seventyseven patients with histologically verified DTC, proven resistance to radioactive iodine therapy, and tumor progression (according to the Response Evaluation Criteria In Solid Tumors 1.1 criteria) were included in the study. Results.Median progression-free survival in patients included into analysis (n = 72) was 26.1 months. In patients who responded to therapy (including those with partial and complete response), median progression-free survival reached 36.2 months, which is higher than that reported in the updated results of the SELECT study (33.1 months). Lenvatinib-associated adverse events (AEs) were observed in 87 % of patients. Severe AEs were registered in 18.2 % of participants. In 6.5 % of cases, AEs lead to lenvatinib cessation; in 74 % of cases, AEs required dose reduction.Conclusion. Our findings suggest high efficacy and good tolerability of lenvatinib in patients with RR-DTC in routine clinical practice in the Russian Federation.

scholarly journals MON-LB76 Impact of Age on Survival and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Cancer Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Camille Buffet
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factors ◽  
Differentiated Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Progression Free Survival ◽  
Therapeutic Management ◽  
Duration Of Treatment ◽  
Free Survival ◽  
Secondary Endpoints ◽  
Systemic Therapies

Abstract BACKGROUND Age has been identified as a major prognostic factor in differentiated thyroid cancer (DTC). Prognostic factors of radioiodine-refractory differentiated thyroid cancer (RAIR-DTC) are poorly described. The objectives of our study were to analyze the influence of age on the survival of patients with RAIR-DTC and to determine their prognostic factors according to age. PATIENTS AND METHOD This single centre, retrospective study enrolled 155 patients diagnosed with a RAIR-DTC between 1991 and 2017. The primary end point was overall survival (OS). Secondary endpoints were progression free survival (PFS) and prognostic factors. RESULTS Median OS was 8.2 years (95% IC: 5.3-9.6). There was no difference according to age (P = 0.47) with median OS at 8.3 years in patients < 65 (95% IC: 4.9-10), and 7.5 years in patients > 65 (IC: 4,9-11,3). PFS after RAIR-diagnosis was 2.1 years (95% IC: 0.8-3) in patients < 65, and 1 year in patients > 65 (95% IC: 0.34-0.68). In both groups, progressive disease despite 131I reduced OS, in comparison with other RAIR criteria. In patients < 65, an interval between the initial diagnosis of DTC and the diagnosis of RAIR metastatic disease more than 3 years was protective from poor OS (HR: 2.12; 95% CI: 1.05-4.27). In patients > 65, presence of a mediastinum metastasis at RAIR-diagnosis was a significant factor for decreased OS (HR: 0.22; 95% CI: 0.11-0.44). No difference was found between groups regarding therapeutic management. One third of patients received tyrosine kinase inhibitors in both groups (< 65 years: 20 patients (28%), ≥ 65 years: 28 (33%), P = 0.49). They were also similar regarding the number of lines received or the median duration of treatment (< 65 years: 19.5 months (2-59), ≥ 65 years: 19 months (1-64), p= 0.35). At least one line of TKI was transitorily or definitively withdrawn due to toxicity in 40% of patients (< 65 years: 8/20 patients (40%), ≥ 65 years: 13/28 (46%), p= 0,037). CONCLUSION In RAIR-DTC patients, age was not predictive of the outcome. In our study, older patients seem to have benefited from intensive therapeutic management. Continual progress made in the management of RAIR-DTC, especially with the implementation of systemic therapies should probably make reconsider the natural history and conventional prognostic factors of RAIR-DTC.

Predicting distant metastatic disease in differentiated thyroid cancer: a matched case–control study

2021 ◽  
Vol 91 (4) ◽  
pp. 716-723
Author(s):  
Sukaina Jaffar ◽  
Jayani Jayasekara ◽  
Ahmad M. Aniss ◽  
Venessa H. M. Tsang ◽  
Diana L. Learoyd ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Metastatic Disease ◽  
Differentiated Thyroid Cancer ◽  
Case Control Study ◽  
Case Control ◽  
Distant Metastatic Disease ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

scholarly journals Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987–2012

2015 ◽  
Vol 100 (9) ◽  
pp. 3270-3279 ◽  
Author(s):  
Aubrey A. Carhill ◽  
Danielle R. Litofsky ◽  
Douglas S. Ross ◽  
Jacqueline Jonklaas ◽  
David S. Cooper ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Distant Metastatic Disease ◽  
Risk Patients ◽  
Disease Free

Context: Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer. Objective: The objective was to examine effects of initial therapies on outcomes. Design/Setting: This was a prospective multi-institutional registry. Patients: A total of 4941 patients, median follow-up, 6 years, participated. Intervention: Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST). Main Outcome Measure: Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses. Results: Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1–3. Conclusions: We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.

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