To treat or not to treat: developments in the field of advanced differentiated thyroid cancer.
BACKGROUND
Thyroid cancer is the most prevalent endocrine malignancy. Based on the increased understanding of thyroid tumourigenesis, novel therapeutic agents have been identified. However, given the low incidence, the good prognosis of the majority of these tumours and the limited evidence of different treatment modalities, a wide variety of treatment strategies are available. These are mostly based on small studies, data from retrospective analyses and the particular experiences of treating physicians. We discuss the recent developments in the treatment of advanced differentiated thyroid cancer.


METHODS
Three cases demonstrate the considerations involved in treatment decisions for patients with advanced thyroid cancer. The first patient achieved stable disease for over five years with different targeted therapies. The second patient shows the potential (severe) toxicity of these drugs and the third patient illustrates the indolent nature of this disease.


CONCLUSIONS
The treatment of patients with extensively metastasised thyroid cancer is very complicated. The timing of initiation of therapy and the potential toxicity of targeted therapies are important in the clinical decision to treat or not to treat because of the slowly progressive course of differentiated thyroid cancer. When targeted therapy is considered, it remains of great importance to enrol patients in clinical studies in order to further determine the position of these therapies, to develop more effective (combination) treatment schemes, and above all, to identify those patients that truly benefit.
Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
T C
TC
Schneider
E
E
Kapiteijn
E P
EP
Corssmit
S F
SF
Oosting
A N A
AN
van der Horst-Schrivers
T P
TP
Links
D018263:Adenocarcinoma, Follicular / Q000473:pathology; D000368:Aged; D017321:Clinical Trials, Phase I as Topic; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000494:pharmacology; D010671:Phenylurea Compounds / Q000494:pharmacology*; D047428:Protein Kinase Inhibitors / Q000494:pharmacology*; D000077157:Sorafenib; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib