Treatment of advanced medullary thyroid carcinoma with a combination of recombinant interferon alpha-2b and octreotide.
BACKGROUND
The medical treatment of advanced medullary thyroid carcinoma (MTC) is still questionable. Results of chemotherapy are disappointing with almost no curative responses, few partial responses, and many side-effects. A recent report has suggested the activity of combination recombinant interferon alpha-2b (rIFN-alpha-2b) and octreotide, a somatostatin analogue, in the treatment of a metastatic carcinoid tumor. This new therapeutic schedule may be used in other neuroendocrine tumors. In this study we evaluated the therapeutic effectiveness of octreotide and rIFN-alpha-2b in patients with advanced MTC.


METHODS
Eight patients affected by advanced MTC received octreotide at a daily dose of 150 micrograms for 6 months and subsequently at a daily dose of 300 micrograms for another 6 months, subcutaneously, and rIFN-alpha-2b at a daily dose of 5.000.000 IU intramuscularly 3 times a week for 12 months. Plasma calcitonin, carcinoembryonic antigenic levels, and morphologic staging were evaluated at 0, 1, 3, 6, and 12 months.


RESULTS
The therapy was stopped in two patients because of diarrhea and toxicity of drugs used. Pre-existing diarrhea in four patients and flushing in one significantly improved during treatment. A maximum decrease of calcitonin was reached after 1 month in 2 patients and after 3 months in 4. In all of the patients carcinoembryonic antigen levels decreased during treatment. No significant changes of size of metastases were observed.


CONCLUSIONS
The combination of octreotide and interferon is well tolerated and can be recommended for the treatment of advanced MTC.
Lupoli
G
G
Department of Molecular and Clinical Endocrinology and Oncology, School of Medicine, University, Federico II, Naples, Italy.
Cascone
E
E
Arlotta
F
F
Vitale
G
G
Celentano
L
L
Salvatore
M
M
Lombardi
G
G
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002116:Calcitonin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis; D018276:Carcinoma, Medullary / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000556:secondary; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015282:Octreotide / Q000008:administration & dosage; D011994:Recombinant Proteins; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology
D002272:Carcinoembryonic Antigen; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D002116:Calcitonin; D015282:Octreotide