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甲状腺癌的靶向治疗:最新进展

Targeted Therapy in Thyroid Cancer: State of the Art.

作者信息

Valerio L, Pieruzzi L, Giani C, Agate L, Bottici V, Lorusso L, Cappagli V, Puleo L, Matrone A, Viola D, Romei C, Ciampi R, Molinaro E, Elisei R

机构信息

Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy.

Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy.

出版信息

Clin Oncol (R Coll Radiol). 2017 May;29(5):316-324. doi: 10.1016/j.clon.2017.02.009. Epub 2017 Mar 17.

Abstract

Thyroid cancer typically has a good outcome following standard treatments, which include surgery, radioactive iodine ablation for differentiated tumours and treatment with thyrotropine hormone-suppressive levothyroxine. Thyroid cancers that persist or recur following these therapies have a poorer prognosis. Cytotoxic chemotherapy or external beam radiotherapy has a low efficacy in these patients. 'Target therapy' with tyrosine kinase inhibitors (TKIs) represent an important therapeutic option for the treatment of advanced cases of radioiodine refractory (RAI-R) differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC) and possibly for cases of poorly differentiated (PDTC) and anaplastic thyroid cancer (ATC). In the last few years, several TKIs have been tested for the treatment of advanced, progressive and RAI-R thyroid cancers and some of them have been recently approved for use in clinical practice: sorafenib and lenvatinib for DTC and PDTC; vandetanib and cabozantinib for MTC. The objective of this overview is to present the current status of the treatment of advanced DTC, MTC, PDTC and ATC with the use of TKIs by describing the benefits and the limits of their use. A comprehensive analysis and description of the molecular basis of these drugs and the new therapeutic perspectives are also reported. Some practical suggestions are also given for the management to the potential side-effects of these drugs.

摘要

甲状腺癌在接受包括手术、对分化型肿瘤进行放射性碘消融以及使用促甲状腺激素抑制性左甲状腺素治疗等标准治疗后,通常预后良好。经这些治疗后仍持续或复发的甲状腺癌预后较差。细胞毒性化疗或外照射放疗对这些患者疗效较低。使用酪氨酸激酶抑制剂(TKIs)进行“靶向治疗”是治疗放射性碘难治性(RAI-R)分化型甲状腺癌(DTC)、髓样甲状腺癌(MTC)晚期病例的重要治疗选择,可能对低分化(PDTC)和未分化甲状腺癌(ATC)病例也适用。在过去几年中,几种TKIs已被用于测试治疗晚期、进展性和RAI-R甲状腺癌,其中一些最近已被批准用于临床实践:索拉非尼和仑伐替尼用于DTC和PDTC;凡德他尼和卡博替尼用于MTC。本综述的目的是通过描述使用TKIs治疗晚期DTC、MTC、PDTC和ATC的益处和局限性,介绍其治疗现状。还报告了对这些药物分子基础的全面分析和描述以及新的治疗前景。针对这些药物潜在副作用的管理也给出了一些实用建议。

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