title: Treatment of advanced medullary thyroid carcinoma with a combination of cyclophosphamide, vincristine, and dacarbazine.
abstract: BACKGROUND
  Medullary thyroid carcinoma (MTC) is a neoplasm of the parafollicular C cells of the thyroid gland, which belongs to the diffuse neuroendocrine system. This cancer usually behaves in a relatively indolent manner for most patients. However, approximately 20% of patients have a more aggressive course that requires effective management. There are few reported clinical trials of chemotherapy for MTC. From the literature, the most active agent appears to be doxorubicin, with response rates of 30% reported. On the basis of the activity of cyclophosphamide, vincristine, and dacarbazine (CVD) in other advanced neuroendocrine neoplasms, the authors tested the combination in patients with advanced MTC.
  
  
  METHODS
  Seven patients with advanced MTC were treated with cyclophosphamide (750 mg/m2), vincristine (1.4 mg/m2), and dacarbazine (600 mg/m2 daily for 2 days in each cycle) every 3 weeks. Assessments of measurable tumor and serum calcitonin and carcinoembryonic antigen were made before treatment and followed up until progressive disease was documented.
  
  
  RESULTS
  Two patients had partial tumor and biochemical responses for a duration of 14 and 29 months, respectively. One patient had a partial biochemical response and stable tumor measurements for 9 months, and another patient had stable tumor size and markers for 14 months. Three patients had progressive disease. Diarrhea and flushing improved in two patients who had partial biochemical responses.
  
  
  CONCLUSIONS
  Our experience suggests that CVD chemotherapy has moderate activity and is well tolerated in patients with advanced MTC. Additional prospective studies of this regimen for MTC are required.
authors.affiliation: Department of Neoplastic Diseases, Mount Sinai Medical Center, New York, New York 10029.
authors.forename: L T
authors.initials: LT
authors.lastname: Wu
authors.forename: S D
authors.initials: SD
authors.lastname: Averbuch
authors.forename: D W
authors.initials: DW
authors.lastname: Ball
authors.forename: A
authors.initials: A
authors.lastname: de Bustros
authors.forename: S B
authors.initials: SB
authors.lastname: Baylin
authors.forename: W P
authors.initials: WP
authors.lastname: McGuire
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002116:Calcitonin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018276:Carcinoma, Medullary / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D002272:Carcinoembryonic Antigen; D014750:Vincristine; D003606:Dacarbazine; D003520:Cyclophosphamide; D002116:Calcitonin