Unusual short-term complete response to two regimens of cytotoxic chemotherapy in a patient with poorly differentiated thyroid carcinoma.
BACKGROUND
Treatment modalities for progressive iodine-refractory poorly differentiated thyroid carcinomas are not yet well defined. Molecular targeted therapy with multikinase inhibitors has recently shown promising results, and cytotoxic chemotherapy is generally considered of low efficacy.


OBJECTIVE
We report the case of a 57-yr-old woman with an advanced iodine-refractory poorly differentiated thyroid cancer who was treated sequentially between October 2006 and March 2011 with two different regimens of cytotoxic chemotherapy and three lines of multikinase inhibitors.


METHODS
Efficacy and adverse effects of the consecutive treatment modalities, i.e. vandetanib, doxorubicin-cisplatin combination, sorafenib, paclitaxel-carboplatin combination, and sunitinib, are reported.


RESULTS
The patient presented a complete tumor response to a doxorubicin-cisplatin combination lasting 10 months and to a paclitaxel-carboplatin regimen lasting 5 months and had no or limited response to kinase inhibitors, i.e. progression after 3 months of vandetanib, progression after 4 months of sorafenib, and stable disease for 8 months with sunitinib treatment.


CONCLUSIONS
When tumor progresses with kinase inhibitors, cytotoxic chemotherapy may be an alternative in selected cases of advanced iodine-refractory poorly differentiated thyroid cancer. For those rare cases, clinical management should benefit from a multidisciplinary team approach through specialized networks.
Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, F-14076 Caen Cedex 05, France.
Geneviève
G
Crouzeix
Jean-Jacques
JJ
Michels
Emmanuel
E
Sevin
Nicolas
N
Aide
Dominique
D
Vaur
Stéphane
S
Bardet
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007211:Indoles / Q000008:administration & dosage; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D017239:Paclitaxel / Q000008:administration & dosage; D010671:Phenylurea Compounds; D010880:Piperidines / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage; D011758:Pyrroles / Q000008:administration & dosage; D011799:Quinazolines / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D000077157:Sorafenib; D000077210:Sunitinib; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000628:therapy; D013965:Thyroidectomy; D014057:Tomography, X-Ray Computed
D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D001557:Benzenesulfonates; D007211:Indoles; D007457:Iodine Radioisotopes; D010671:Phenylurea Compounds; D010880:Piperidines; D011725:Pyridines; D011758:Pyrroles; D011799:Quinazolines; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D009536:Niacinamide; D004317:Doxorubicin; D000077157:Sorafenib; D017239:Paclitaxel; D002945:Cisplatin; D000077210:Sunitinib; C452423:vandetanib