Kanteti Aditya Pavan Kumar, Abraham George, Patil Vijay M, Menon Nandini, Mandal Tanmoy, Jacob Sobin V, Garg Keshav, Sekar Anbarasan, Sarma Rup Jyoti, Mekala Laxma Reddy, Nakti Dipti, Mittal Neha, Bal Munita, Rane Swapnil, Purandare Nilendu C, Mahajan Abhishek, Sable Nilesh, Kumar Suman, Noronha Vanita, Prabhash Kumar
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012 India.
Department of Pathology, Tata Memorial Hospital, Mumbai, India.
Indian J Surg Oncol. 2022 Mar;13(1):61-67. doi: 10.1007/s13193-021-01381-x. Epub 2021 Aug 15.
There is a paucity of evidence of the impact of sorafenib on MCT and it is the preferred therapy used in India. We decided to do an audit of all patients of MCT who were referred to us for systemic therapy. The objective of this exercise was to identify the treatment pattern, outcomes, and adverse events with therapy in MCT. Baseline demographics (age, gender, ECOG PS, comorbidities, habits), tumor details (site of metastasis), previous treatment details, clinical features at metastasis (symptomatic or asymptomatic), the pattern of treatment, adverse events (CTCAE version 4.02), date of progression, date of death and status, and follow-up were extracted from the rare tumor database and electronic medical records. Out of 75 patients referred for therapy for MCT, 47 (62.7%) patients were considered for immediate tyrosine kinase inhibitors as they had symptomatic status and 28 (37.3%) patients were kept on observation due to the asymptomatic nature of the disease. Out of the 28 patients, 15 (53.6%, n = 28) patients were subsequently started on TKI while in 13 (46.4%, n = 28) patients observation was continued. In the overall cohort, the median PFS was 18.9 months (95% CI 11.9-29.9) and OS was 26.6 months (95% CI 14.4-39.0). Among variables tested, only female gender had an impact on PFS (hazard ratio = 0.364 95% CI 0.148-0.895; P = 0.028) and the absence of lung metastasis had a positive impact on OS (hazard ratio = 0.443 95% CI 0.207-0.95; P = 0.037). Most commonly used TKI was sorafenib (n = 61) and sunitinib in 1 patient. The most common adverse events with TKI were palmo-plantar dysesthesia (50, 80.6%) and oral mucositis (25, 40.2%). The strategy of treating symptomatic MCT and observing in asymptomatic MCT is associated with reasonable PFS and OS. Sorafenib is the most commonly used TKI in our setup and provides similar outcomes as globally.
关于索拉非尼对转移性去分化甲状腺癌（MCT）影响的证据不足，而它是印度常用的首选治疗方法。我们决定对所有转诊至我们这里接受全身治疗的MCT患者进行一次审核。此次审核的目的是确定MCT治疗的模式、结果及不良事件。从罕见肿瘤数据库和电子病历中提取了基线人口统计学信息（年龄、性别、东部肿瘤协作组体能状态、合并症、习惯）、肿瘤详情（转移部位）、既往治疗详情、转移时的临床特征（有症状或无症状）、治疗模式、不良事件（美国国立癌症研究所不良事件通用术语标准4.02版）、疾病进展日期、死亡日期及状态以及随访情况。在75例转诊接受MCT治疗的患者中，47例（62.7%）患者因有症状而被考虑立即使用酪氨酸激酶抑制剂，28例（37.3%）患者因疾病无症状而进行观察。在这28例患者中，15例（53.6%，n = 28）患者随后开始使用酪氨酸激酶抑制剂，13例（46.4%，n = 28）患者继续观察。在整个队列中，中位无进展生存期（PFS）为18.9个月（95%可信区间11.9 - 29.9），总生存期（OS）为26.6个月（95%可信区间14.4 - 39.0）。在检测的变量中，仅女性性别对PFS有影响（风险比 = 0.364，95%可信区间0.148 - 0.895；P = 0.028），无肺转移对OS有积极影响（风险比 = 0.443，95%可信区间0.207 - 0.95；P = 0.037）。最常用的酪氨酸激酶抑制剂是索拉非尼（n = 61），1例患者使用舒尼替尼。酪氨酸激酶抑制剂最常见的不良事件是手足感觉异常（50例，80.6%）和口腔黏膜炎（25例，40.2%）。治疗有症状MCT并观察无症状MCT的策略与合理的PFS和OS相关。索拉非尼是我们机构最常用的酪氨酸激酶抑制剂，其疗效与全球相似。
