Porcelli Tommaso, Luongo Cristina, Cerbone Anna, Di Luccio Carmine, Nacchio Mariantonia, De Stefano Maria Angela, Schlumberger Martin, Salvatore Domenico
Eur Thyroid J. 2025 Feb 7;14(1). doi: 10.1530/ETJ-24-0332. Print 2025 Feb 1.
To analyse at our institution the criteria for selecting a first-line therapy for patients with advanced radioiodine-refractory thyroid cancer and their clinical responses, safety and survival outcomes.
We extracted data from 69 consecutive patients referred to Federico II University Hospital from September 2016 to September 2024, among whom 44 patients were treated with TKIs as first-line treatment and outside any clinical trial, and form the basis of this report.
Thirty-one (71%) patients were treated with the antiangiogenesis inhibitor lenvatinib and 13 (29%) were treated with selective tyrosine kinase inhibitors (s-TKIs). Among the latter, eight patients were treated with dabrafenib + trametinib (DT), two patients were treated with selpercatinib because of contraindications to lenvatinib, and three patients received DT as redifferentiation therapy. A RECIST partial response was observed in 28% of patients treated with lenvatinib, in 63% of those treated with DT and in one of the two patients treated with selpercatinib. Grade ≥3 adverse events occurred in 13 (42%) patients treated with lenvatinib and only in 1 (9%) patient treated with DT. Progression-free survival (PFS) and overall survival rates at 1 year were 72% and 83% in lenvatinib-treated patients and 69% and 83% in DT-treated patients, respectively. In both selpercatinib-treated patients, the PFS at data cut-off was 10 months. No treatment-related deaths were observed.
S-TKIs permitted tailoring systemic treatment based on disease location, tumour volume and patient comorbidities, achieving satisfactory tolerance and outcomes in selected patients with an actionable driver mutation and with contraindications to angiogenesis inhibitors or candidates for redifferentiation therapy.
在我们的机构分析晚期放射性碘难治性甲状腺癌患者一线治疗的选择标准及其临床反应、安全性和生存结果。
我们提取了2016年9月至2024年9月转诊至费德里科二世大学医院的69例连续患者的数据，其中44例患者在无任何临床试验的情况下接受了酪氨酸激酶抑制剂（TKIs）作为一线治疗，这些数据构成了本报告的基础。
31例（71%）患者接受抗血管生成抑制剂乐伐替尼治疗，13例（29%）患者接受选择性酪氨酸激酶抑制剂（s-TKIs）治疗。在后者中，8例患者接受达拉非尼+曲美替尼（DT）治疗，2例患者因乐伐替尼禁忌而接受塞尔帕替尼治疗，3例患者接受DT作为再分化治疗。接受乐伐替尼治疗的患者中有28%观察到RECIST部分缓解，接受DT治疗的患者中有63%观察到部分缓解，接受塞尔帕替尼治疗的2例患者中有1例观察到部分缓解。接受乐伐替尼治疗的13例（42%）患者发生≥3级不良事件，而接受DT治疗的患者中仅1例（9%）发生。乐伐替尼治疗患者1年的无进展生存率（PFS）和总生存率分别为72%和83%，DT治疗患者分别为69%和83%。在接受塞尔帕替尼治疗的2例患者中，数据截止时的PFS均为10个月。未观察到与治疗相关的死亡。
s-TKIs允许根据疾病部位、肿瘤体积和患者合并症来定制全身治疗，在有可操作驱动突变、对血管生成抑制剂有禁忌或作为再分化治疗候选者的特定患者中实现了令人满意的耐受性和结果。
