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放射性碘难治性转移性甲状腺癌患者短期再分化的可行性

Feasibility of Short-Term Redifferentiation in Patients with Radioactive Iodine-Refractory Metastatic Thyroid Cancer.

作者信息

von Hinten Johannes, Viering Oliver, Bundschuh Ralph A, Cagliyan Feyza, Wengenmair Hermann, Pfob Christian H, Nagarajah James, Lapa Constantin, Kircher Malte

机构信息

Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.

Department of Nuclear Medicine, University of Dresden, Dresden, Germany.

出版信息

J Nucl Med. 2025 Aug 1;66(8):1192-1196. doi: 10.2967/jnumed.125.270055.

Abstract

Radioactive iodine-refractory thyroid cancer (TC) has a poor prognosis, and restoring iodine uptake is a major therapeutic goal. Recent studies have used tyrosine kinase inhibitors (TKIs) for 3-6 wk to achieve redifferentiation, but preclinical data suggest that maximal effects occur within 8-12 d. In this retrospective study, 8 patients with metastatic radioactive iodine-refractory TC received trametinib plus dabrafenib (for -mutated disease) or trametinib alone (for wild-type disease) for 10 d. Iodine uptake was assessed by I-scintigraphy; responders received high-dose radioactive iodine therapy, and nonresponders continued TKIs for another 10 d. Two patients (both with wild-type disease) achieved successful iodine uptake restoration with significant thyroglobulin reduction after radioactive iodine therapy. Extending TKI treatment to 21 d did not yield further benefit. Our pilot study supports preclinical findings that maximal restoration of iodine uptake is achieved after only 10 d of TKI therapy, reducing toxicity and treatment costs. Longer treatment did not provide any additional benefit. Larger prospective trials are needed to confirm these findings.

摘要

放射性碘难治性甲状腺癌(TC)预后较差,恢复碘摄取是主要治疗目标。近期研究使用酪氨酸激酶抑制剂(TKIs)3至6周以实现再分化,但临床前数据表明最大效应在8至12天内出现。在这项回顾性研究中,8例转移性放射性碘难治性TC患者接受曲美替尼加达拉非尼(用于 -突变疾病)或单独使用曲美替尼(用于野生型疾病)治疗10天。通过碘闪烁扫描评估碘摄取;有反应者接受高剂量放射性碘治疗,无反应者继续使用TKIs治疗另外10天。两名患者(均为野生型疾病)在放射性碘治疗后成功恢复碘摄取并显著降低甲状腺球蛋白。将TKI治疗延长至21天未产生进一步益处。我们的初步研究支持临床前研究结果,即仅10天的TKI治疗即可实现碘摄取的最大恢复,降低毒性和治疗成本。更长时间的治疗未提供任何额外益处。需要更大规模的前瞻性试验来证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ac3/12320577/6b1a7ec2ad64/jnumed.125.270055absf1.jpg

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