Pitoia F, Jerkovich F, Trimboli P, Smulever A. New approaches for patients with advanced radioiodine-refractory thyroid cancer. World J Clin Oncol 2022; 13(1): 9-27 [PMID: 35116229 DOI: 10.5306/wjco.v13.i1.9]
Corresponding Author of This Article
Fabián Pitoia, MD, PhD, Doctor, Division of Endocrinology, Hospital de Clínicas José de San Martin, University of Buenos Aires, Córdoba 2351, Fifth Floor, Buenos Aires 1120, Argentina. fpitoia@intramed.net
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Jan 24, 2022; 13(1): 9-27 Published online Jan 24, 2022. doi: 10.5306/wjco.v13.i1.9
New approaches for patients with advanced radioiodine-refractory thyroid cancer
Fabián Pitoia, Fernando Jerkovich, Pierpaolo Trimboli, Anabella Smulever
Fabián Pitoia, Fernando Jerkovich, Anabella Smulever, Division of Endocrinology, Hospital de Clínicas José de San Martin, University of Buenos Aires, Buenos Aires 1120, Argentina
Pierpaolo Trimboli, Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano 1111, Switzerland
Pierpaolo Trimboli, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano 1111, Switzerland
Author contributions: Pitoia F contributed to the conception and design of the article and revised it; Jerkovich F and Smulever A drafted the article; Trimboli P contributed interpreting the relevant literature; all authors have read and approve the final manuscript.
Conflict-of-interest statement: Fabian Pitoia is speaker of Bayer, Knight and Raffo. The other authors certify that there is no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabián Pitoia, MD, PhD, Doctor, Division of Endocrinology, Hospital de Clínicas José de San Martin, University of Buenos Aires, Córdoba 2351, Fifth Floor, Buenos Aires 1120, Argentina. fpitoia@intramed.net
Received: April 8, 2021 Peer-review started: April 12, 2021 First decision: August 18, 2021 Revised: August 31, 2021 Accepted: December 31, 2021 Article in press: December 31, 2021 Published online: January 24, 2022
Abstract
The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma (DTC) has exponentially increased. Approximately 10% of patients with DTC exhibit recurrent or metastatic disease, and about two-thirds of the latter will be defined as refractory to radioactive iodine (RAIR) treatment. Since this condition implies 10-year survival rates less than 10% after detection, using available treatments, such as systemic and targeted therapies, have become increasingly relevant. The initiation of these treatments aims to reach stabilization, tumor volume reduction, and/or symptom improvement and it should be decided by highly specialized endocrinologists/ oncologists on the basis of patient’s features. Considering that despite enlarged progression-free survival was proven, multikinase inhibitors remain non-curative, their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction. In this context, molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy, progression free survival, overall survival and adverse events profile. This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC, including approved target therapies as well as those for off-label use, RAI resensitization agents, and immunotherapy.
Core Tip: The incidence of differentiated thyroid carcinoma has increased due to the rising detection of low-risk small carcinomas. Nevertheless, approximately 10% of patients exhibit advanced disease and two-thirds of the latter will be defined as radioactive iodine (RAI) refractory. After detection, 10-year survival rates are less than 10%, therefore the role of systemic and targeted therapy in these patients has become increasingly relevant in recent years. This review article aims to provide a summary of the current therapeutic strategies in iodine-refractory thyroid cancer, including approved target therapies as well as those for off-label use, RAI resensitization agents, and immunotherapy.
