Radyoaktif iyot refrakter diferansiye tiroid kanserli hastalarda sorafenib kullanımının etkinliğinin retrospektif incelenmesi
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Date
2022
Authors
Duran, Abdülkerim
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Tiroid kanserleri genel olarak iyi prognozlu kanserlerdir ve çoğunluğu tiroid follikül epitel kökenlidir. Papiller tiroid kanseri (PTK), folliküler tiroid kanseri (FTK), hurthle hücreli tiroid kanseri (HHTK) ve az diferansiye tiroid kanseri diferansiye tiroid kanserleri (DTK) olarak isimlendirilmektedir. Genel olarak cerrahi ve radyoaktif iyot (RAI) tedavisine iyi yanıt verirler. Bu kanserlerin az bir kısmı daha agresif bir forma dönüşerek RAI tedavisine direnç geliştirir ve RAI refrakter DTK olarak isimlendirilirler. RAI refrakter DTK tedavisinde tirozin kinaz inhibitörleri önemli bir tedavi seçeneği haline gelmiştir. Sorafenib tirozin kinaz inhibitörü olup RAI refrakter DTK tedavisinde kullanılmaktadır. Çalışmamızda radyoaktif iyot refrakter (RAIR) diferansiye tiroid kanserli hastalarda sorafenib kullanımının etkinliğinin retrospektif olarak incelenmesi amaçlanmıştır. Çalışmamızda 2010-2022 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi’nde endokrinoloji ve onkoloji polikliniklerinde RAIR-DTK tanısı ile takip edilen ve tedavi olarak sorafenib kullanan 19 hastanın dosyası retrospektif olarak incelendi. On üç hasta papiller tiroid karsinomu, 5 hasta folliküler tiroid karsinomu ve 1 hasta az diferansiye tiroid karsinomu tanısı almıştı. Medyan progresyonsuz sağkalım (PFS) 16,1 ay, medyan genel sağkalım (OS) 36,2 ay olarak bulundu. Sadece akciğer metastazı olmasının, yaşın 55’den büyük veya küçük olmasının, tanının PTK veya FTK olmasının ve cinsiyetin PFS’ı etkilemediği görüldü. Tam yanıtlı hasta yoktu. Objektif cevap oranı %15,8, hastalık kontrol oranı %84,2 olarak bulundu. Hastaların %63,2’sinde yan etki görüldü ve en sık görülen yan etki el-ayak sendromuydu. Çalışmamızda RAIR-DTK tanılı hastalarda alt gruplardan bağımsız olarak sorafenib kullanımının PFS üzerine olumlu etkisi olduğu gösterilmiştir.
Most thyroid tumors are of papillary cell origin and generally are associated with a good prognosis. Differentiated thyroid cancers (DTC) include papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), Hürthle cell thyroid cancer (HTC), and poorly differentiated thyroid cancer (PDTC). These tumors respond well to surgery and radioactive iodine (RAI) treatment. RAI refractory DTC refers to tumors that have become more aggressive and developed resistance to RAI treatment. Tyrosine kinase inhibitors have become an important treatment option in the treatment of RAI refractory DTC. Sorafenib is a tyrosine kinase inhibitor and is used in the treatment of RAI refractory DTC. Our study aimed to retrospectively examine the use of sorafenib in patients with radioactive iodine refractory (RAIR) differentiated thyroid cancer. In our study, we retrospectively reviewed the electronic health records of 19 patients who were treated with sorafenib and followed up with RAIR-DTC in the outpatient oncology and endocrinology clinics of Bursa Uludag University Faculty of Medicine Hospital between 2010 and 2022. 13 patients were diagnosed with papillary thyroid carcinoma, 5 with follicular thyroid carcinoma, and 1 with poorly differentiated thyroid carcinoma. Median progression-free survival (PFS) was 16.1 months, and median overall survival (OS) was 36.2 months. In terms of PFS, there was no difference in the presence of only lung metastases, age over or under 55, PTC or FTC diagnosis, or gender. No patient achieved a complete response. The objective response rate was 15.8%, and the disease control rate was 84.2%. 63.2% of the patients experienced adverse events, with hand-foot syndrome being the most common. Our study has revealed that sorafenib treatment improves PFS in patients diagnosed with RAIR-DTC regardless of subgroups.
Most thyroid tumors are of papillary cell origin and generally are associated with a good prognosis. Differentiated thyroid cancers (DTC) include papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), Hürthle cell thyroid cancer (HTC), and poorly differentiated thyroid cancer (PDTC). These tumors respond well to surgery and radioactive iodine (RAI) treatment. RAI refractory DTC refers to tumors that have become more aggressive and developed resistance to RAI treatment. Tyrosine kinase inhibitors have become an important treatment option in the treatment of RAI refractory DTC. Sorafenib is a tyrosine kinase inhibitor and is used in the treatment of RAI refractory DTC. Our study aimed to retrospectively examine the use of sorafenib in patients with radioactive iodine refractory (RAIR) differentiated thyroid cancer. In our study, we retrospectively reviewed the electronic health records of 19 patients who were treated with sorafenib and followed up with RAIR-DTC in the outpatient oncology and endocrinology clinics of Bursa Uludag University Faculty of Medicine Hospital between 2010 and 2022. 13 patients were diagnosed with papillary thyroid carcinoma, 5 with follicular thyroid carcinoma, and 1 with poorly differentiated thyroid carcinoma. Median progression-free survival (PFS) was 16.1 months, and median overall survival (OS) was 36.2 months. In terms of PFS, there was no difference in the presence of only lung metastases, age over or under 55, PTC or FTC diagnosis, or gender. No patient achieved a complete response. The objective response rate was 15.8%, and the disease control rate was 84.2%. 63.2% of the patients experienced adverse events, with hand-foot syndrome being the most common. Our study has revealed that sorafenib treatment improves PFS in patients diagnosed with RAIR-DTC regardless of subgroups.
Description
Keywords
Radyoaktif iyot direnci, Diferansiye tiroid kanseri, Sorafenib, Progresyonsuz sağkalım, Radioactive iodine-resistance, Differentiated thyroid cancer, Sorafenib, Progression-free survival
Citation
Duran, A. (2022). Radyoaktif iyot refrakter diferansiye tiroid kanserli hastalarda sorafenib kullanımının etkinliğinin retrospektif incelenmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.