Weitzman Steven P, Cabanillas Maria E
Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cancer Manag Res. 2015 Aug 19;7:265-78. doi: 10.2147/CMAR.S68373. eCollection 2015.
Although patients with thyroid cancer generally fare well, there is a subset for which this is not necessarily true. Progress in understanding the molecular aberrations in thyroid cancer has led to a change in the management of these cases. Since 2011, four multikinase inhibitors (MKIs) have been approved by the US Food and Drug Administration for thyroid cancer - cabozantinib and vandetanib for medullary thyroid cancer and sorafenib and lenvatinib for differentiated thyroid cancer. This change in the treatment landscape has raised challenges for practitioners who may not be familiar with the use of MKIs or with the treatment and natural history of advanced thyroid cancer in general. This article reviews the epidemiology, molecular drivers, and initial treatment of patients with thyroid cancer and offers practical guidance to assist with the determination of when to appropriately start an MKI. As an example, cabozantinib and its efficacy are discussed in detail. Close monitoring is required for all patients on targeted agents to assess for adverse effects and response to therapy. An approach to managing drug-related adverse events is detailed. Since these drugs are not curative and have not yet proven to prolong overall survival, it is critical to weigh the risks and benefits of treatment at every visit. The potential value of changing to a different agent following failure of an MKI is also addressed.
虽然甲状腺癌患者总体预后良好，但有一部分患者并非如此。对甲状腺癌分子异常的认识进展导致了这些病例管理方式的改变。自2011年以来，美国食品药品监督管理局已批准四种多激酶抑制剂（MKIs）用于治疗甲状腺癌——卡博替尼和凡德他尼用于治疗髓样甲状腺癌，索拉非尼和乐伐替尼用于治疗分化型甲状腺癌。治疗格局的这种变化给那些可能不熟悉MKIs使用方法或总体上不熟悉晚期甲状腺癌治疗及自然病程的从业者带来了挑战。本文回顾了甲状腺癌患者的流行病学、分子驱动因素及初始治疗，并提供实用指导，以帮助确定何时恰当地开始使用MKI。例如，详细讨论了卡博替尼及其疗效。对于所有接受靶向药物治疗的患者，都需要密切监测，以评估不良反应和治疗反应。详细介绍了处理药物相关不良事件的方法。由于这些药物并非治愈性药物，且尚未证明能延长总生存期，因此每次就诊时权衡治疗的风险和益处至关重要。还讨论了MKI治疗失败后换用不同药物的潜在价值。
