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Onkologische Welt 2015; 06(06): 255-259
DOI: 10.1055/s-0038-1631567
Innovation Schilddrüse
Schattauer GmbH

Systemic treatment of advanced differentiated and medullary thyroid cancer

Overview and practical aspectsSystemische Behandlung des fortgeschrittenen differenzierten und medullären Schilddrüsen -karzinoms
M. C. Kreissl
1   Department of Nuclear Medicine, Central Hospital of Augsburg, Germany
2   Department of Nuclear Medicine, University Hospital, University of Wuerzburg, Germany
,
M. Fassnacht
3   Division of Endocrinology, Dept. of Internal Medicine I, University Hospital, University of Wuerzburg, Germany
,
S. P. Mueller
4   Department of Nuclear Medicine, University Hospital of Essen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2018 (online)

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Zusammenfassung

In den vergangenen Jahren wurden drei neue Substanzen für die molekular gezielte Therapie des fortgeschrittenen und progredienten Schilddrüsenkarzinoms zugelassen: Vandetanib und Cabozantinib für das medulläre Schilddrüsenkarzinom sowie Sorafenib für das Radioiod-refraktäre differenzierte Schilddrüsenkarzinom. Die Selektion der Patienten durch ein interdisziplinäres Team sowie die Aufklärung der Patienten spielt eine wesentliche Rolle, wenn diese Behandlung in Betracht gezogen bzw. begonnen wird. Nur Patienten mit hoher Tumorlast und/oder symptomatischer bzw. progredienter Erkrankung, die lokalen Therapien nicht zugänglich ist, sollten behandelt werden. Um eine gute Lebensqualität zu erhalten, ist das Management der unerwünschten Arzneimittelwirkungen von größter Bedeutung. Aufgrund der Wirkweise der Tyrosinkinasehemmer ist der Verlauf der Tumormarker Calcitonin und Thyreoglobulin nur bedingt zur Beurteilung des Therapieansprechens und zum Follow-up geeignet, deshalb kommt der morphologischen und metabolischen Bildgebung besondere Bedeutung zu. Ein umschriebener oder geringer Progress sollte nicht unbedingt die Beendigung der Behandlung oder eine Therapieumstellung nach sich ziehen. In der nahen Zukunft werden weitere Substanzen verfügbar sein.

Summary

In the last few years, three new drugs for targeted systemic therapies have been approved for advanced and progressive thyroid cancer, namely vandetanib and cabozantinib for medullary and sorafenib for radioiodine refractory differentiated thyroid cancer. Patient selection by an interdisciplinary team and education of patients by the treating physicians play a major role when such a treatment is considered and initiated. Only patients with significant tumor burden and/ or symptomatic disease or progression, which cannot be controlled by local therapies, should be treated. In order to preserve quality of life, the management of adverse effects is of utmost importance. Due to the mechanism of action of these tyrosine kinase inhibitors, the reliability of serum tumour markers, calcitonin and thyroglobulin, is limited for the assessment of response and follow-up, therefore morphological and metabolic imaging is of great importance. Minor or localized progression should not automatically trigger the termination of treatment or change of drug. In the near future, it is expected that additional drugs become available.

Schlüsselwörter

Medulläres Schilddrüsenkarzinom - differenziertes Schilddrüsenkarzinom - systemische Therapie - Tyrosinkinasehemmer

Keywords

Medullary thyroid carcinoma - differentiated thyroid cancer - systemic therapy - tyrosine kinase inhibitor
 

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