Colombo Carla, De Leo Simone, Trevisan Matteo, Giancola Noemi, Scaltrito Anna, Fugazzola Laura
Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico, Italiano, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Front Oncol. 2022 Jul 4;12:903532. doi: 10.3389/fonc.2022.903532. eCollection 2022.
In a minority of differentiated thyroid cancer (TC) cases and in a large percentage of poorly differentiated TCs (PDTCs) and anaplastic TCs (ATCs), the prognosis is poor due to the lack of response to conventional treatments. In the last two decades, multikinase inhibitor (MKI) compounds have been developed and demonstrated to be very effective in these aggressive cases. Besides the great efficacy, several adverse events (AEs) have been reported in virtually all patients treated with MKIs, largely overlapping between different compounds and including hypertension, diarrhea, anorexia, decreased weight, fatigue, and proteinuria. Most grade 3-4 adverse reactions occur during the first 6 months of treatment and require dosage reduction and/or drug discontinuation. Due to severity of the AEs related to the treatment with MKIs, a multidisciplinary team is definitely required for the daily management of these patients, for the evaluation of the disease status, and the psychophysical condition. Moreover, it is crucial that the patients could have a facilitated access to reach either specialist doctors or nurses who must have been trained to follow them for their individual clinical complications. The follow-up visits should take place at monthly intervals until the sixth month and then every 1-2 months until the completion of the first year of treatment. The flow chart followed at our tertiary center is reported in the present review as a real-life-based example for the follow-up of patients with advanced TC on MKI treatment.
在少数分化型甲状腺癌（TC）病例以及大部分低分化TC（PDTC）和未分化TC（ATC）中，由于对传统治疗无反应，预后较差。在过去二十年中，多激酶抑制剂（MKI）化合物已被开发出来，并证明在这些侵袭性病例中非常有效。除了疗效显著外，几乎所有接受MKI治疗的患者都报告了一些不良事件（AE），不同化合物之间的不良事件有很大重叠，包括高血压、腹泻、厌食、体重减轻、疲劳和蛋白尿。大多数3-4级不良反应发生在治疗的前6个月，需要减少剂量和/或停药。由于与MKI治疗相关的AE的严重性，在这些患者的日常管理、疾病状态评估和身心状况评估方面，绝对需要一个多学科团队。此外，至关重要的是，患者能够方便地接触到经过培训以跟踪其个体临床并发症的专科医生或护士。随访应每月进行一次，直到第六个月，然后每1-2个月进行一次，直到治疗满一年。在本综述中报告了我们三级中心遵循的流程图，作为接受MKI治疗的晚期TC患者随访的一个基于实际情况的例子。
