Luster M, Lassmann M, Haenscheid H, Michalowski U, Incerti C, Reiners C
Department of Nuclear Medicine, University of Wuerzburg, Germany.
J Clin Endocrinol Metab. 2000 Oct;85(10):3640-5. doi: 10.1210/jcem.85.10.6903.
The use of 131I for radioablative therapy in patients with differentiated thyroid cancer (DTC) requires a sufficient serum concentration of TSH for efficient thyroid tissue uptake of iodine. We describe the use of recombinant human TSH (rhTSH) in conjunction with ablative radioiodine therapy (RIT) in 11 patients (16 total treatments) with advanced and/or recurrent DTC (5 papillary, 6 follicular) for whom withdrawal of thyroid hormone suppression therapy (THST), the standard method to increase serum TSH, was not an option. Indications for rhTSH use in these patients included inability to tolerate withdrawal of thyroid hormones due to very poor physical condition or inability to achieve sufficient serum TSH levels after THST withdrawal. Ten patients had undergone thyroidectomy, and most (9 of 11) had received prior ablative RIT after THST withdrawal. Baseline thyroglobulin levels ranged from 25 to nearly 30,000 ng/mL, reflecting the heterogeneity of the patient population. In 7 cases (5 patients), posttherapy thyroglobulin levels assessed at a mean of 4.3 months (range, 2-10 months) after 131I therapy were decreased by at least 30% compared to pretherapy levels. In follow-up visits, an additional 3 patients showed marked clinical improvement or decreased or stabilized tumor burden in whole body scans compared to pretherapy scans. Three patients died of progressive disease within 2 months of therapy before follow-up assessments occurred. No adverse events were reported among the 8 surviving patients. The results suggest that rhTSH offers a promising alternative to THST withdrawal to allow ablative RIT after effective TSH stimulation in patients with advanced recurrent DTC who would not otherwise be able to receive this treatment. This therapeutic indication extends the clinical potential of this new agent, already demonstrated to be effective for use with 131I for diagnostic purposes.
对于分化型甲状腺癌（DTC）患者，使用¹³¹I进行放射性消融治疗需要足够的血清促甲状腺激素（TSH）浓度，以便甲状腺组织有效摄取碘。我们描述了重组人促甲状腺激素（rhTSH）联合放射性碘消融治疗（RIT）在11例晚期和/或复发性DTC患者（共16次治疗）中的应用，这些患者（5例乳头状癌，6例滤泡状癌）无法采用甲状腺激素抑制治疗（THST）撤药这一增加血清TSH的标准方法。在这些患者中使用rhTSH的指征包括因身体状况极差无法耐受甲状腺激素撤药，或在THST撤药后无法达到足够的血清TSH水平。10例患者接受了甲状腺切除术，大多数患者（11例中的9例）在THST撤药后接受过放射性碘消融治疗。基线甲状腺球蛋白水平在25至近30,000 ng/mL之间，反映了患者群体的异质性。在7例患者（5例个体）中，¹³¹I治疗后平均4.3个月（范围2 - 10个月）评估的治疗后甲状腺球蛋白水平与治疗前水平相比至少降低了30%。在随访中，另外3例患者与治疗前扫描相比，全身扫描显示临床明显改善或肿瘤负荷降低或稳定。3例患者在治疗后2个月内死于疾病进展，未进行随访评估。8例存活患者中未报告不良事件。结果表明，对于晚期复发性DTC患者，rhTSH为THST撤药提供了一种有前景的替代方法，使这些患者在有效TSH刺激后能够接受放射性碘消融治疗，否则他们将无法接受这种治疗。这种治疗指征扩展了这种新药的临床潜力，该药已被证明用于¹³¹I诊断有效。
