碘难治性分化型甲状腺癌诊断与治疗的研究进展
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摘要
放射性碘难治性分化型甲状腺癌(RAIR-DTC)的预后通常较差,且不易早期诊断,一旦发生远处转移,缺乏控制其进展的有效手段,对于伴随症状或潜在风险高的转移灶,通常以手术切除以及体外放疗等局部治疗方法来控制疾病进展。随着对RAIR-DTC分子生物学研究的深入,靶向药物治疗为疾病控制提供了新的方法,多激酶抑制剂包括索拉非尼和乐伐替尼已被Ⅲ期临床试验证明可以改善患者的无进展生存期,但同时也造成了一些不良反应。作用在其他靶点多激酶抑制剂也在进行临床试验,可为该疾病的治疗提供更多的选择。
Generally radioiodine refractory differentiated thyroid carcinoma( RAIR-DTC) has very poor prognosis,which is also not easy to diagnose in early stage. In the case of distant metastasis there was no effective treatment to prevent the progress. For metastatic lesions with symptoms or potential high risk,the treatment has been limited to local therapies like surgery and radiotherapy to prevent its progress. With the advancement of molecular biologic research regarding to RAIRDTC targeted drug treatment provides a new method for the disease control. Multi-targeted kinase inhibitors including sorafenib and lenvatinib have been proved to improve progression-free survival in the phase Ⅲ clinical trial. However,they are also associated with several adverse reactions. Other targeted kinase inhibitors are in clinical trials,which provide more choices for the treatment of the disease.
Generally radioiodine refractory differentiated thyroid carcinoma( RAIR-DTC) has very poor prognosis,which is also not easy to diagnose in early stage. In the case of distant metastasis there was no effective treatment to prevent the progress. For metastatic lesions with symptoms or potential high risk,the treatment has been limited to local therapies like surgery and radiotherapy to prevent its progress. With the advancement of molecular biologic research regarding to RAIRDTC targeted drug treatment provides a new method for the disease control. Multi-targeted kinase inhibitors including sorafenib and lenvatinib have been proved to improve progression-free survival in the phase Ⅲ clinical trial. However,they are also associated with several adverse reactions. Other targeted kinase inhibitors are in clinical trials,which provide more choices for the treatment of the disease.
引文
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[34]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[35]张鑫,王宸,梁军,等.进展性碘难治性分化型甲状腺癌患者阿帕替尼治疗后血清学与影像学指标变化[J].中国肿瘤临床,2017,44(8):371-376.
[36]Donskov F,Michaelson MD,Puzanov I,et al.Sunitinib-associated hypertension and neutropenia as efficacy biomarkers in metastatic renal cell carcinoma patients[J].Br J Cancer,2015,113(11):1571-1580.
[37]Fabián P,Fernando J.Selective use of sorafenib in the treatment of thyroid cancer[J].Drug Des Devel Ther,2016,10:1119-1131.
[38]Yun KJ,Kim W,Kim EH,et al.Accelerated disease progression after discontinuation of sorafenib in a patient with metastatic papillary thyroid cancer[J].Endocr Metab,2014,29(3):388-393.
[2]Perros P,Boelaert K,Colley S,et al.Guidelines for the management of thyroid cancer[J].Clin Endocrinol,2014,81(Suppl 1):1-122.
[3]Cancer Australia.Thyroid Cancer 2017.2017-03-01[2018-02-01].https://canceraustralia.gov.au/affected-cancer/cancertypes/thyroid-cancer/thyroid-cancer-statistics.
[4]Shaha AR.Recurrent differentiated thyroid cancer[J].Endocr Prac,2012,18(4):600-603.
[5]Nixon IJ,Whitcher MM,Palmer FL,et al.The impact of distant metastases at presentation on prognosis in patients with differentiated carcinoma of the thyroid gland[J].Thyroid,2012,22(9):884-889.
[6]Durante C,Haddy N,Baudin E,et al.Long-term outcome of 444patients with distant metastases from papillary and follicular thyroid carcinoma:Benefits and limits of radioiodine therapy[J].J Clin Endocr Metab,2006,91(8):2892-2899.
[7]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26(1):1-133.
[8]Cooray SD,Topliss DJ.The management of metastatic radioiodine refractory differentiated thyroid cancer requires an integrated approach including both directed and systemic therapies[J].Endocr Diab Metab Case Rep,2017,2017(1):16-0089.
[9]Riesco-Eizaguirre G,Galofre JC,Grande E,et al.Spanish consensus for the management of patients with advanced radioactive iodine refractory differentiated thyroid cancer[J].Endocrinol Nutr,2016,63(4):e17-24.
[10]Schlumberger M,Catargi B,Borget I,et al.Strategies of radioiodine ablation in patients with low-risk thyroid cancer[J].N Eng J med,2012,366(6):1663-1673.
[11]Pelttari H,Valimaki MJ,Loyttyniemi E,et al.Post-ablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma:A 16-year follow-up study[J].Eur J Endocrinol,2010,163(5):757-763.
[12]Mallick U,Harmer C,Yap B,et al.Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer[J].N Eng J med,2012,366(18):1674-1685.
[13]Feine U,Lietzenmayer R,Hanke JP,et al.Fluorine-18-FDG and iodine-131-iodide uptake in thyroid cancer[J].J Nucl Med,1996,37(9):1468-1472.
[14]Ahmadi S,Stang M,Jiang X,et al.Hürthle cell carcinoma:Current perspectives[J].Onco Targets Ther,2016,9:6873-6884.
[15]Hassoun AA,Hay ID,Goellner JR,et al.Insular thyroid carcinoma in adolescents:A potentially lethal endocrine malignancy[J].Cancer,1997,79(5):1044-1048.
[16]Schmidt A,Iglesias L,Klain M,et al.Radioactive iodine-refractory differentiated thyroid cancer:An uncommon but challenging situation[J].Arch Endocrinol Metab,2017,61(1):81.
[17]Rondeau G,Fish S,Hann LE,et al.Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression[J].Thyroid,2011,21(8):845-853.
[18]Guenette JP,Monchik JM,Dupuy DE.Image-guided ablation of postsurgical locoregional recurrence of biopsy-proven well-differentiated thyroid carcinoma[J].J Vasc Interv Radiol,2013,24(5):672-679.
[19]Kiess AP,Agrawal N,Brierley JD,et al.External-beam radiotherapy for differentiated thyroid cancer locoregional control:A statement of the American Head and Neck Society[J].Head Neck,2016,38(4):493-498.
[20]Muresan MM,Olivier P,Leclere J,et al.Bone metastases from differentiated thyroid carcinoma[J].Endocr Relat Cancer,2008,15(1):37-49.
[21]Orita Y,Sugitani I,Toda K,et al.Zoledronic acid in the treatment of bone metastases from differentiated thyroid carcinoma[J].Thyroid,2011,21(12):31-35.
[22]林岩松,杨雪.碘难治性甲状腺癌的诊治进展[J].中国癌症杂志,2017,27(6):442-450.
[23]Wilhelm SM,Adnane L,Newell P,et al.Preclinical overview of sorafenib,a multikinase inhibitor that targets both Raf and VEGF and PDGF receptor tyrosine kinase signaling[J].Mol Cancer Ther,2008,7(10):3129-3140.
[24]Brose MS,Nutting CM,Jarzab B,et al.Sorafenib in radioactive iodine-refractory,locally advanced or metastatic differentiated thyroid cancer:A randomised,double-blind,phase 3 trial[J].Lancet,2014,384(9940):319-328.
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[34]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[35]张鑫,王宸,梁军,等.进展性碘难治性分化型甲状腺癌患者阿帕替尼治疗后血清学与影像学指标变化[J].中国肿瘤临床,2017,44(8):371-376.
[36]Donskov F,Michaelson MD,Puzanov I,et al.Sunitinib-associated hypertension and neutropenia as efficacy biomarkers in metastatic renal cell carcinoma patients[J].Br J Cancer,2015,113(11):1571-1580.
[37]Fabián P,Fernando J.Selective use of sorafenib in the treatment of thyroid cancer[J].Drug Des Devel Ther,2016,10:1119-1131.
[38]Yun KJ,Kim W,Kim EH,et al.Accelerated disease progression after discontinuation of sorafenib in a patient with metastatic papillary thyroid cancer[J].Endocr Metab,2014,29(3):388-393.