Romagnoli Serena, Moretti Sonia, Voce Pasquale, Puxeddu Efisio
Department of Internal Medicine, University of Perugia, Perugia, Italy.
Arq Bras Endocrinol Metabol. 2009 Dec;53(9):1061-73. doi: 10.1590/s0004-27302009000900002.
Thyroid cancer incidence has significantly increased in the last three decades and many patients seek medical attention for its treatment every year. Among follicular cell-derived tumors, the majority are differentiated thyroid carcinomas (DTC), whose prognosis is very good with only 15% of the cases presenting disease persistence or recurrence after initial treatment. Medullary thyroid carcinoma has a worse prognosis, especially in patients with diffused cancers at the time of initial surgery. Traditional treatment options for persistent or recurrent disease include additional surgery, radioiodine treatment and TSH-suppression in DTC patients; external beam radiotherapy, and cytotoxic chemotherapy, often have low efficacy and many patients with advanced disease ultimately die. In the last two decades many of the molecular events involved in cancer formation have been uncovered. This knowledge has prompted the development of novel therapeutic strategies mainly based on the inhibition of key molecular mediators of the tumorigenic process. In particular the class of small-molecule tyrosine kinase inhibitors was enriched by many compounds that have reached clinical trials and in some cases have had approval for clinical use in specific cancers. Many of these compounds entered clinical trials also for locally advanced or metastatic thyroid carcinomas showing very promising results.
在过去三十年中，甲状腺癌的发病率显著上升，每年都有许多患者寻求医疗治疗。在滤泡细胞源性肿瘤中，大多数是分化型甲状腺癌（DTC），其预后非常好，初始治疗后仅有15%的病例出现疾病持续或复发。甲状腺髓样癌的预后较差，尤其是在初次手术时患有弥漫性癌症的患者中。持续性或复发性疾病的传统治疗选择包括对DTC患者进行额外手术、放射性碘治疗和促甲状腺激素抑制；外照射放疗和细胞毒性化疗通常疗效较低，许多晚期疾病患者最终死亡。在过去二十年中，许多与癌症形成相关的分子事件已被揭示。这一知识促使了主要基于抑制肿瘤发生过程关键分子介质的新型治疗策略的发展。特别是小分子酪氨酸激酶抑制剂类别中有许多化合物已进入临床试验，在某些情况下已获批用于特定癌症的临床治疗。其中许多化合物也进入了局部晚期或转移性甲状腺癌的临床试验，显示出非常有前景的结果。
