University of Sydney Endocrine Surgical Unit, St. Leonards, New South Wales, Australia.
Oncologist. 2010;15(2):146-56. doi: 10.1634/theoncologist.2009-0190. Epub 2010 Feb 8.
Differentiated thyroid cancer accounts for >90% of cases of thyroid cancer, with most patients having an excellent prognosis. Distant metastases occur in 10%-15% of patients, decreasing the overall 10-year survival rate in this group to 40%. Radioactive iodine has been the mainstay of treatment for distant metastases, with good results when lesions retain the ability to take up iodine. For patients with metastatic disease resistant to radioactive iodine, treatment options are few and survival is poor. Chemotherapy and external beam radiotherapy have been used in these patients, but with disappointing results. In recent years, our understanding of the molecular pathways involved in thyroid cancer has increased and a number of molecular targets have been identified. These targets include the proto-oncogenes BRAF and RET, known to be common mutations in thyroid cancer; vascular endothelial growth factor receptor and platelet-derived growth factor receptor, associated with angiogenesis; and the sodium-iodide symporter, with the aim of restoring its expression and hence radioactive iodine uptake. There are now multiple trials of tyrosine kinase inhibitors, angiogenesis inhibitors, and other novel agents available to patients with metastatic thyroid cancer. This review discusses both traditional and novel treatments for metastatic differentiated thyroid cancer with a particular focus on emerging treatments for patients with radioactive iodine-refractory disease.
分化型甲状腺癌占甲状腺癌的>90%，大多数患者预后良好。10%-15%的患者发生远处转移，这组患者的总体 10 年生存率降低至 40%。放射性碘一直是治疗远处转移的主要方法，当病灶保留摄取碘的能力时，效果良好。对于放射性碘耐药的转移性疾病患者，治疗选择很少，生存状况较差。这些患者曾接受过化疗和外照射放疗，但结果令人失望。近年来，我们对甲状腺癌涉及的分子途径的认识有所增加，并且已经确定了一些分子靶点。这些靶点包括原癌基因 BRAF 和 RET，已知是甲状腺癌的常见突变；血管内皮生长因子受体和血小板衍生生长因子受体，与血管生成有关；以及钠碘转运体，目的是恢复其表达，从而摄取放射性碘。目前有多种针对转移性甲状腺癌的酪氨酸激酶抑制剂、血管生成抑制剂和其他新型药物的临床试验。这篇综述讨论了转移性分化型甲状腺癌的传统和新型治疗方法，特别关注放射性碘难治性疾病患者的新兴治疗方法。
