Nervo Alice, Ferrari Matteo, Vaccaro Elisa, Migliore Enrica, Gruosso Giovanni, Roux Anna, Piovesan Alessandro, Arvat Emanuela
Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy.
Cancer Epidemiology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy.
Endocrine. 2025 Feb;87(2):724-733. doi: 10.1007/s12020-024-04061-2. Epub 2024 Oct 2.
In differentiated/poorly differentiated (DTC/PDTC) or medullary thyroid cancer (MTC) treated with kinase inhibitors (KIs), additional treatments (ATs) can be performed in selected cases.
We retrospectively analysed all the ATs performed in our center in KI-treated TC patients, evaluating the subsequent KI modulation, the local PD in case of loco-regional procedure (LRP) and the AT-related complications. DTC/PDTC patients with or without progressive disease before the first AT (PD and NO PD GROUP, respectively) were analysed separately.
In our center, 32 ATs (30 LRPs and 2 radioactive iodine treatments) were performed in 14 DTC/PDTC patients and 4 MTC subjects after the start of systemic therapy with lenvatinib or vandetanib (27 and 5 ATs, respectively). Brain was the most treated site (11/30 LRPs) and external beam radiation was the most employed LRP (18/30 LRPs). KIs dose reduction or discontinuation of KI therapy (at least transient) was performed after 50% of ATs in DTC/PDTC NO PD GROUP. The KI was maintained at the same dosage after 75% and 50% of the ATs performed in DTC/PDTC PD GROUP and MTC, respectively. During the follow-up, local PD was detected after 14 LRPs. Local progression-free survival (LPFS) was significantly shorter in DTC/PDTC PD GROUP in comparison to NO PD GROUP (12 month-LPFS 91.7% versus 15.2%); in patients with MTC, 12 month-LPFS was 50%. AT-related AEs were mostly G1-G2.
In selected DTC/PDTC without previous PD and treated with a multimodal strategy, local disease control is generally maintained regardless the KI dose modulation. In DTC/PDTC patients with previous limited PD and in MTC subjects, the choice of performing a LRP and continue the ongoing KI therapy must consider the risk of early local progression. AT-related AEs in KI treated patients were mild in most cases.
在用激酶抑制剂（KIs）治疗的分化型/低分化型（DTC/PDTC）或甲状腺髓样癌（MTC）中，部分病例可进行额外治疗（ATs）。
我们回顾性分析了本中心对接受KIs治疗的甲状腺癌患者进行的所有ATs，评估后续KIs调整、局部区域手术（LRP）时的局部进展以及与AT相关的并发症。分别分析了首次AT前有或无疾病进展的DTC/PDTC患者（分别为疾病进展组和无疾病进展组）。
在本中心，14例DTC/PDTC患者和4例MTC患者在开始使用乐伐替尼或凡德他尼进行全身治疗后进行了32次ATs（30次LRP和2次放射性碘治疗）（分别为27次和5次ATs）。脑部是接受治疗最多的部位（11/30次LRP），外照射是最常用的LRP（18/30次LRP）。在DTC/PDTC无疾病进展组中，50%的ATs后进行了KIs剂量降低或KI治疗中断（至少是暂时中断）。在DTC/PDTC疾病进展组和MTC中，分别有75%和50%的ATs后KI维持相同剂量。随访期间，14次LRP后检测到局部进展。与无疾病进展组相比，DTC/PDTC疾病进展组的局部无进展生存期（LPFS）显著缩短（12个月LPFS为91.7%对15.2%）；在MTC患者中，12个月LPFS为50%。与AT相关的不良事件大多为1-2级。
在采用多模式策略治疗且之前无疾病进展的特定DTC/PDTC中，无论KI剂量如何调整，通常都能维持局部疾病控制。在之前有局限性疾病进展的DTC/PDTC患者和MTC患者中，进行LRP并继续当前KI治疗的选择必须考虑早期局部进展的风险。在接受KI治疗的患者中，与AT相关的不良事件在大多数情况下较轻。
