title: Targeted therapy of thyroid cancer.
abstract: Systemic chemotherapies for advanced or metastatic thyroid carcinomas have been of only limited effectiveness. For patients with differentiated or medullary carcinomas unresponsive to conventional treatments, novel therapies are needed to improve disease outcomes. Multiple novel therapies primarily targeting angiogenesis have entered clinical trials for metastatic thyroid carcinoma. Partial response rates up to 30% have been reported in single agent studies, but prolonged disease stabilization is more commonly seen. The most successful agents target the vascular endothelial growth factor receptors, with potential targets including the mutant kinases associated with papillary and medullary oncogenesis. Two drugs approved for other malignancies, sorafenib and sunitinib, have had promising preliminary results reported, and are being used selectively for patients who do not qualify for clinical trials. Additional agents targeting tumor vasculature, nuclear receptors, epigenetic abnormalities, and the immune response to neoplasia have also been investigated. Randomized trials for several agents are underway that may lead to eventual drug approval for thyroid cancer. Treatment for patients with metastatic or advanced thyroid carcinoma now emphasizes clinical trial opportunities for novel agents with considerable promise. Alternative options now exist for use of tyrosine kinase inhibitors that are well tolerated and may prove worthy of regulatory approval for this disease.
authors.affiliation: The University of Texas M D Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1432, Houston, TX 77030, USA. sisherma@mdanderson.org
authors.forename: Steven I
authors.initials: SI
authors.lastname: Sherman
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D044127:Epigenesis, Genetic / Q000187:drug effects; D006801:Humans; D007167:Immunotherapy; D009389:Neovascularization, Pathologic / Q000517:prevention & control; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D018160:Receptors, Cytoplasmic and Nuclear / Q000187:drug effects; D013964:Thyroid Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000201:enzymology
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D018160:Receptors, Cytoplasmic and Nuclear