title: Efficacy of sorafenib and impact on cardiac function in patients with thyroid cancer: a retrospective analysis.
abstract: OBJECTIVE
  Sorafenib has recently been recognized as an important standard option for the management of patients with differentiated thyroid cancer. Although data concerning cardiac safety are available in pan-tumor studies, no data are available on its use in everyday clinical practice in patients with thyroid cancer.
  
  
  METHODS
  In the off-label program of our institution, we enrolled 14 patients with different histological types of thyroid cancer suitable for treatment with sorafenib. Our aims were to evaluate cardiac safety factors-LVEF (left ventricular ejection fraction), heart rate and blood pressure-the cardiac markers NT-proBNP and troponin I, radiological response evaluated by CT and (18)FDG-PET (according to RECIST 1.1 criteria) and biomarker reduction (Eastern Cooperative Oncology Group Performance Status: ECOG PS) 0-2.
  
  
  RESULTS
  Patients with ECOG PS 2 accounted for 36%. After starting sorafenib, many patients displayed reduced or stabilized metabolic activity in target lesions (clinical benefit = 44%), radiologic reduction or stabilization (74%) and decreased cancer markers (90%). Lung metastases displayed the largest reductions in size. Median overall survival (OS) was 7 months and median progression-free survival (PFS) was 3 months. No sign of cardiotoxicity was observed in almost all patients. LVEF was altered in two patients and proved symptomatic in one.
  
  
  CONCLUSIONS
  Sorafenib seems to be effective in reducing disease progression in the early stages of treatment (3-6 months). Responses varied considerably according to the criteria investigated. Cardiac toxicities did not raise concerns and were in line with data reported in other malignancies. However, cardiac monitoring is recommended.
authors.affiliation: Endocrine Unit, IRCSS IST-San Martino University Hospital, 16132, Genoa, Italy, lollom@hotmail.it.
authors.forename: L
authors.initials: L
authors.lastname: Mortara
authors.forename: G
authors.initials: G
authors.lastname: Pera
authors.forename: E
authors.initials: E
authors.lastname: Monti
authors.forename: S
authors.initials: S
authors.lastname: Morbelli
authors.forename: F
authors.initials: F
authors.lastname: Minuto
authors.forename: G
authors.initials: G
authors.lastname: Sambuceti
authors.forename: M
authors.initials: M
authors.lastname: Giusti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D013318:Stroke Volume / Q000502:physiology*; D013964:Thyroid Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib