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Verburg, Frederik Anton [Author]; Amthauer, Holger [Author]; Binse, Ina [Author]; Brink, Ingo [Author]; Buck, Andreas K. [Author]; Darr, Andreas [Author]; Dierks, Christine [Author]; Koch, Christine [Author]; König, Ute [Author]; Kreißl, Michael [Author]; Luster, Markus [Author]; Reuter, Christoph Wolfgang Maria [Author]; Scheidhauer, Klemens [Author]; Willenberg, Holger [Author]; Zielke, Andreas [Author]; Schott, Matthias [Author]

Questions and controversies in the clinical application of tyrosine kinase inhibitors to treat patients with radioiodine-refractory differentiated thyroid carcinoma: expert perspectives

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  • Media type: E-Book; Special Print
  • Title: Questions and controversies in the clinical application of tyrosine kinase inhibitors to treat patients with radioiodine-refractory differentiated thyroid carcinoma: expert perspectives
  • Contributor: Verburg, Frederik Anton [VerfasserIn]; Amthauer, Holger [VerfasserIn]; Binse, Ina [VerfasserIn]; Brink, Ingo [VerfasserIn]; Buck, Andreas K. [VerfasserIn]; Darr, Andreas [VerfasserIn]; Dierks, Christine [VerfasserIn]; Koch, Christine [VerfasserIn]; König, Ute [VerfasserIn]; Kreißl, Michael [VerfasserIn]; Luster, Markus [VerfasserIn]; Reuter, Christoph Wolfgang Maria [VerfasserIn]; Scheidhauer, Klemens [VerfasserIn]; Willenberg, Holger [VerfasserIn]; Zielke, Andreas [VerfasserIn]; Schott, Matthias [VerfasserIn]
  • imprint: Stuttgart [u.a.]: Thieme, 2021
  • Published in: Hormone and metabolic research ; 53, 03 (2021), 149-160
  • Extent: 1 Online-Ressource (12 Seiten)
  • Language: English
  • DOI: 10.1055/a-1380-4154
  • ISSN: 1439-4286
  • Identifier:
  • Origination:
  • Footnote:
  • Description: Abstract: Notwithstanding regulatory approval of lenvatinib and sorafenib to treat radioiodine-refractory differentiated thyroid carcinoma (RAI-R DTC), important questions and controversies persist regarding this use of these tyrosine kinase inhibitors (TKIs). RAI-R DTC experts from German tertiary referral centers convened to identify and explore such issues; this paper summarizes their discussions. One challenge is determining when to start TKI therapy. Decision-making should be shared between patients and multidisciplinary caregivers, and should consider tumor size/burden, growth rate, and site(s), the key drivers of RAI-R DTC morbidity and mortality, along with current and projected tumor-related symptomatology, co-morbidities, and performance status. Another question involves choice of first-line TKIs. Currently, lenvatinib is generally preferred, due to greater increase in progression-free survival versus placebo treatment and higher response rate in its pivotal trial versus that of sorafenib; additionally, in those studies, lenvatinib but not sorafenib showed overall survival benefit in subgroup analysis. Whether recommended maximum or lower TKI starting doses better balance anti-tumor effects versus tolerability is also unresolved. Exploratory analyses of lenvatinib pivotal study data suggest dose-response effects, possibly favoring higher dosing; however, results are awaited of a prospective comparison of lenvatinib starting regimens. Some controversy surrounds determination of net therapeutic benefit, the key criterion for continuing TKI therapy: if tolerability is acceptable, overall disease control may justify further treatment despite limited but manageable progression. Future research should assess potential guideposts for starting TKIs; fine-tune dosing strategies and further characterize antitumor efficacy; and evaluate interventions to prevent and/or treat TKI toxicity, particularly palmar-plantar erythrodysesthesia and fatigue
  • Access State: Open Access