Senar EBINC, Zeynep ORUÇ, Zuhat URAKÇI, Muhammet Ali KAPLAN, Mehmet KÜÇÜKÖNER, Abdurrahman IŞIKDOĞAN

İleri Evre Medüller Tiroid Kanseri Tedavisinde Tirozin Kinaz İnhibitörü Kullanımı-Tek Merkez Deneyimi

Giriş: Medüller tiroid kanseri nadir görülen tiroid kanserlerindendir. Hastaların %5-10 kadarı uzak metastaz ile başvurmaktadır. Metastatik hastalıkta göreceli olarak sitotoksik kemoterapilere dirençli olan bu kanser tipinde tirozin kinaz inhibitörleriyle uzun süre stabil yanıt elde edilebilmektedir. Bu çalışmada medüller tiroid kanserinde tirozin kinaz inhibitörleri kullanımı ve tedavi yanıtlarını incelemeyi amaçladık. Yöntemler: 2006-2019 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Onkoloji Kliniği’ne başvurmuş olan lokal ileri veya metastatik medüller tiroid kanseri tanılı hastaların klinik özellikleri, aldıkları tedaviler ve tedaviye yanıtları retrospektif olarak incelendi. Bulgular: Çalışmamıza 2006-2019 yılları arasında kliniğimize başvuran metastatik medüller tiroid kanserli 12 hasta alındı. Hastalarımızın 4’ü (%33,3) kadın, 8’i (%66,7) ise erkek idi. Her iki cinsiyette ortalama yaş 44.5 (24-67) yıldı. Sekiz (%66) hastada sadece lenf nodu veya yumuşak doku metastazı varken, 3 (%25) hastada hem kemik hem de visseral organ metastazı mevcut idi. Bir (%8,3) hastada ise sadece kemik metastazı vardı. On iki hastamızın 2’sinde medüller tiroid kanseri multiple endokrin neoplazi 2A sendromunun bir parçası idi. Birinci basamak tedavide 5 hasta sitotoksik kemoterapi almıştı. Bu hastalarda progresyonsuz sağkalım 6 ay olarak izlendi. On iki hastamızın hepsi birinci veya ikinci basamakta tirozin kinaz inhibitörü kullanmıştı. Birinci veya ikinci basamakta vandetanib kullanmış olan 10 hastada medyan takip süresi 28 ay idi ve bu hastalarda medyan progresyonsuz sağkalım süresine henüz ulaşılamamıştı. Geriye kalan iki hasta da sorafenib kullanmıştı. Herhangi bir tirozin kinaz inhibitörü kullanan hastalarda ise medyan progresyonsuz sağkalım süresi 40 ay olarak izlendi. Sonuç: Medüller tiroid kanserinin tedavisinde tirozin kinaz inhibitörleri ve özellikle vandetanib kullanımı uzun süreli hastalık stabilizasyonu ve progresyonsuz sağkalım avantajı sağlamaktadır.

The Use of Tyrosine Kinase Inhibitors in Advanced Medullary Thyroid Cancer-Single Center Experience

Objective: Medullary thyroid cancer is one of the rare thyroid cancers. Five-10% of patients present with distant metastasis. In metastatic thyroid medullary cancers, which are relatively resistant to cytotoxic chemotherapies, longterm stable response can be achieved with tyrosine kinase inhibitors. We aimed to investigate the use of tyrosine kinase inhibitors and treatment responses in medullary thyroid cancer. Methods: The clinical features, treatments, and responses to treatment of patients diagnosed with local advanced or metastatic medullary thyroid cancer who applied to Dicle University Faculty of Medicine, Department of Medical Oncology, between 2006 and 2019 were retrospectively analyzed. Results: Twelve patients with metastatic thyroid medullary cancer who admitted to our center between 2006 and 2019 were analyzed. Four (33.3%) of our patients were female and 8 (66.7%) were male, mean age was 44.5 years (range:24- 67 years). Three patients (25%) had both bone and visceral metastases, while eight patients (66%) had only lymph node or soft tissue metastasis, one patient (8.3%) had only bone metastasis. Two of twelve patients had multiple endocrine neoplasia 2A syndrome. Five patients received cytotoxic chemotherapy as first-line treatment. Progression-free survival was 6 months in these patients. All of patients used tyrosine kinase inhibitors as first-line or second-line treatment. Median follow-up of 10 patients who received vandetanib was 28 months and the median progression-free survival could not be reached in these patients. The remaining two patients used sorafenib. Median progression-free survival of the patients using any tyrosine kinase inhibitör was 40 months. Conclusion: The use of tyrosine kinase inhibitors and especially vandetanib in treatment of medullary thyroid cancer provides long-term disease stabilization and progression-free survival.

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