METASTATİK TİROİD KANSERİNDE ALTERNATİF TEDAVİ SEÇENEĞİ: PEPTİD RESEPTÖR RADYONÜKLİD TEDAVİ

Amaç: Bu çalışmada, metastatik tiroid kanserli hastaların tedavisinde peptid reseptörü radyonüklid tedavisinin (PRRT) sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: PRRT ile tedavi edilen metastatik tiroid kanseri olan 10 hasta değerlendirildi. Beş medüller tiroid karsinomu (MTC) ve 5 differansiye tiroid karsinomu (DTC) mevcuttu. Bulgular: İlk PRRT uygulamasında ortalama yaş 61,5 (38-79) yıl ve hastaların 5/10 (%50)’u kadındı. Ortalama genel sağkalım (GSK), ilk PRRT’ den sonra 19,2 ay (%95 CI; 4,1-34,3) idi. Ortalama progresyonsuz sağkalım 4,5 aydı (%95 CI; 2,8-6,3). Patolojik alt grup analizine göre ilk PRRT sonrası ortalama GSK; DTC’de 13,8 ay (%95 CI; 4,0-23,7) ve MTC’de 24,2 (%95 CI; 0-48,8) idi (p:0.555). Beş hastada stabil hastalık, bir hastada kısmi yanıt saptandı. Dört hastada minör hematolojik toksisite gözlendi. Sonuç: PRRT tiroid kanseri için alternatif bir tedavi seçeneği olarak görünmektedir. Hastaların tedaviyi erken evrelerde almasıyla sonuçların daha iyi olacağı düşünülmektedir.

Anahtar Kelimeler:

Radyonüklid tedavi, sağkalım, tiroid kanseri

AN ALTERNATIVE THERAPY OPTION IN METASTATIC THYROID CANCER: PEPTIDE RECEPTOR RADIONUCLIDE THERAPY

Objective: In this study, we aimed to evaluate the results of peptide receptor radionuclide therapy (PRRT) in the treatment of metastatic thyroid cancer patients. Material and Method: In total, 10 patients with metastatic thyroid cancer treated with PRRT were evaluated. There were 5 medullary thyroid cancer (MTC) patients and 5 patients had differentiated thyroid cancer (DTC). Results: Median age at first PRRT was 61.5 (38-79) years and 5/10 (50%) were female. The mean overall survival (OS) was 19.2 months (95% CI; 4.1-34.3) after the first PRRT. The mean progression-free survival (PFS) was 4.5 months (95% CI; 2.8-6.3). According to pathologic subgroup analysis, the mean OS were 13.8 months (95% CI; 4.0-23.7) in DTC and 24.2 (95% CI; 0-48.8) in MTC after first PRRT (p:0.555). Five patients had stable disease and one patient had partial response. Minor hematological toxicity was observed in 4 patients. Conclusion: PRRT appears to be an alternative treatment option for thyroid cancer. It is thought that the results will be more desirable as the patients take the treatment in the earlier stages.

Keywords:

Radionuclide therapy, survival, thyroid cancer,

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1. Mao Y, Xing M. Recent incidences and differential trends of thyroid cancer in the USA. Endocr Relat Cancer 2016;23:313- 22. [CrossRef]
2. Eustatia-Rutten CF, Corssmit EP, Biermasz NR, Pereira AM, Romijn JA, Smit JW. Survival and death causes in differentiated thyroid carcinoma. J Clin Endocrinol Metab 2006;91(1):313-9. [CrossRef]
3. Yang X, Liang J, Li TJ, Yang K, Liang DQ, Yu Z, et al. Postoperative stimulated thyroglobulin level and recurrence risk stratification in differentiated thyroid cancer. Chin Med J 2015;128(8):1058-64. [CrossRef]
4. American Thyroid Association (ATA) Guidelines Task force on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2009;19(11):1167-214. [CrossRef]
5. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer 1998;83(12):2638-48. [CrossRef]
6. Klagge A, Krause K, Schierle K, Steinert F, Dralle H, Fuhrer D. Somatostatin receptor subtype expression in human thyroid tumours. Horm Metab Res 2010;42(4):237-40. [CrossRef]
7. Papotti M, Croce S, Bello M, Bongiovanni M, Allia E, Schindler M, et al. Expression of somatostatin receptor types 2, 3 and 5 in biopsies and surgical specimens of human lung tumours. Correlation with preoperative octreotide scintigraphy. Virchows Arch 2001;439(6):787-97.
8. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97(5):418-28. [CrossRef]
9. Beukhof CM, Brabander T, Nederveen FH, Velthuysen ML, de Rijke YB, Hofland LJ, et al. Peptide receptor radionuclide therapy in patients with medullary thyroid carcinoma: predictors and pitfalls. BMC Cancer 2019;19(1):325. [CrossRef]
10. Wang Y, Wang W, Jin K, Fang C, Lin Y, Xue L, et al. Somatostatin receptor expression indicates improved prognosis in gastroenteropancreatic neuroendocrine neoplasm, and octreotide longacting release is effective and safe in Chinese patients with advanced gastroenteropancreatic neuroendocrine tumors. Oncol Lett 2017;13(3):1165-74. [CrossRef]
11. de Vries LH, Lodewijk L, Willems SM, Dreijerink KMA, de Keizer B, van Diest PJ, et al. SSTR2A expression in medullary thyroid carcinoma is correlated with longer survival. Endocrine 2018;62(3):639-47. [CrossRef]
12. Ruf J, Heuck F, Schiefer J, Denecke T, Elgeti F, Pascher A, et al. Impact of multiphase 68Ga-DOTATOC-PET/CT on therapy management in patients with neuroendocrine tumors. Neuroendocrinology 2010;91(1):101-9. [CrossRef]
13. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab 2006;91(8):2892-99. [CrossRef]
14. Baudin E and Schlumberger M. New therapeutic approaches for metastatic thyroid carcinoma. Lancet Oncol 2007;8(2):148-56. [CrossRef]
15. Biermann K, Biersack HJ, Sabet A, Janzen V. Alternative therapeutic approaches in the treatment of primary and secondary dedifferentiated and medullary thyroid carcinoma. Semin Nucl Med 2011;41(2):139-48. [CrossRef]
16. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26(1):1-133. [CrossRef]
17. Budiawan H, Salavati A, Kulkarni HR, Baum RP. Peptide receptor radionuclide therapy of treatment-refractory metastatic thyroid cancer using (90)Yttrium and (177) Lutetium labeled somatostatin analogs: toxicity, response and survival analysis. Am J Nucl Med Mol Imaging 2013;4(1):39-52.
18. Salavati A, Puranik A, Kulkarni HR, Budiawan H, Baum RP. Peptide receptor radionuclide therapy (PRRT) of medullary and nonmedullary thyroid cancer using radiolabeled somatostatin analogues. Semin Nucl Med 2016;46(3):215- 24. [CrossRef]
19. Ain KB, Taylor KD, Tofiq S, Venkataraman G. Somatostatin receptor subtype expression in human thyroid and thyroid carcinoma cell lines. J Clin Endocrinol Metab 1997;82(6):1857-62. [CrossRef]
20. Versari A, Sollini M, Frasoldati A, Fraternali A, Filice A, Froio A, et al.Differentiated thyroid cancer:a new perspective with radiolabeled somatostatin analogues for imaging and treatment of patients. Thyroid 2014;24(4):715-26. [CrossRef]
21. Martins RG, Rajendran JG, Capell P, Byrd DR, Mankoff DA. Medullary thyroid cancer: options for systemic therapy of metastatic disease? J Clin Oncol 2006;24(11):1653-5. [CrossRef]
22. Kurzrock R, Sherman SI, Ball DW, Forastiere AA, Cohen RB, Mehra R, Pfister DG, et al. Activity of XL184 (Cabozantinib), an Oral Tyrosine Kinase Inhibitor, in Patients With Medullary Thyroid Cancer. J Clin Oncol 2011;29(19):2660-6. [CrossRef]
23. Wells SA Jr, Robinson BG, Gagel RF, Dralle H, Fagin JA, Santoro M, et al.Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer: a randomized, doubleblind phase III trial. J Clin Oncol 2012;30(2):134-41. [CrossRef]
24. Iten F, Müller B, Schindler C, Rochlitz C, Oertli D, Mäcke HR, et al. Response to [90Yttrium-DOTA]-TOC treatment is associated with long-term survival benefit in metastasized medullary thyroid cancer: a phase II clinical trial. Clin Cancer Res 2007;13(22 pt 1):6696-702. [CrossRef]
25. Sippel RS, Kunnimalaiyaan M, Chen H. Current management of medullary thyroid cancer. Oncologist 2008;13(5):539-47. [CrossRef]
26. Salavati A, Prasad V, Schneider CP, Herbst R, Baum RP. Peptide receptor radionuclide therapy of Merkel cell carcinoma using (177) lutetium-labeled somatostatin analogs in combination with radiosensitizing chemotherapy: a potential novel treatment based on molecular pathology. Ann Nucl Med 2012;26(4):365-9. [CrossRef]
27. Schmidt MC, Uhrhan K, Markiefka B, Hasselbring L, Schlaak M, Cremer B, et al. (68)Ga-DotaTATE PET-CT followed by Peptide Receptor Radiotherapy in combination with capecitabine in two patients with Merkel Cell Carcinoma. Int J Clin Exp Med 2012;5(4):363-6.
28. Rolleman EJ, Valkema R, de Jong M, Kooij PP, Krenning EP. Safe and effective inhibition of renal uptake of radiolabelled octreotide by a combination of lysine and arginine. Eur J Nucl Med Mol Imaging 2003;30(1):9-15. [CrossRef]
29. Krenning EP, Kwekkeboom DJ, Valkema R, Pauwels S, Kvols LK, Jong M. Peptide Receptor Radionuclide Therapy. Ann. N.Y. Acad. Sci. 2004;1014:234-45.