Thyroid targeted therapy

The incidence and mortality rates of thyroid cancer in my country have always been very high, especially because the treatment is very difficult. Conventional thyroid cancer treatment uses surgery, but there are still many unsatisfactory aspects. Currently, the most advanced method for treating cancer is targeted therapy. Targeted drugs have good therapeutic effects and can greatly reduce the pain of patients, but there are also some side effects. So, how about thyroid targeted therapy?

Currently, the incidence and mortality of thyroid cancer show an increasing trend year by year. For female cancer patients, the incidence of thyroid adenocarcinoma ranks eighth in the world. Conventional treatments for thyroid cancer mainly include surgery, thyroid-stimulating hormone suppression therapy, and postoperative radioactive iodine-131 therapy. These treatments are effective for most papillary and follicular carcinomas, but are not ideal for some refractory thyroid cancers such as papillary or follicular carcinomas with poor differentiation, strong invasiveness, and poor iodine uptake, as well as medullary or undifferentiated carcinomas. With the progress of research on the molecular mechanism of thyroid cancer in recent years, research on multiple molecular targets including BRAF point mutations, RAS, RET/PTC oncogenes, PAX8/PPARc oncogenes has become increasingly clear, and targeted treatment for refractory thyroid cancer has become a major new direction.

FDA approves targeted drug for thyroid cancer treatment

1. Sorafenib is the first oral small molecule multi-kinase inhibitor that can inhibit the activity of multiple kinases. It mainly inhibits Raf kinase through targeted inhibition, thereby blocking the Raf-MEK-ERK signal transduction pathway, mediating cell apoptosis and inhibiting the proliferation of tumor cells, thereby exerting an anti-tumor effect. The clinical benefits of sorafenib in the treatment of medullary thyroid cancer and recurrent and metastatic differentiated thyroid cancer are relatively clear, but the clinical efficacy of sorafenib in the treatment of anaplastic thyroid cancer is still unclear and requires further evaluation in more clinical trials. During the treatment with sorafenib, pay attention to the occurrence of adverse reactions such as hand-foot skin syndrome and diarrhea, especially during the sorafenib dose adjustment process, you should pay more attention to the occurrence of adverse reactions.

2. Vandetanib is a synthetic aniline quinazoline compound and a multi-target tyrosine kinase inhibitor. The clinical effectiveness of vandetanib in the treatment of patients with radioiodine-resistant advanced thyroid cancer and advanced medullary thyroid cancer has been confirmed by multiple clinical trials. During the treatment with this drug, attention should be paid to the occurrence of adverse reactions such as cardiovascular and digestive system reactions. The overall tolerance of this drug is good.

3. Cabozantinib is a tyrosine kinase inhibitor, and its targets include ME, VEGFR-2, RET, etc. Cabozantinib significantly prolongs the PFS of patients with advanced medullary thyroid cancer, and has obvious clinical efficacy. Adverse drug reactions may include: diarrhea, hand-foot syndrome, weight loss, loss of appetite, nausea, fatigue, etc.

4. Lenvatinib is an oral receptor tyrosine kinase inhibitor with multiple inhibitory targets. It is approved for patients with locally recurrent or metastatic differentiated thyroid cancer that is resistant to radioactive iodine therapy. Other new drugs such as sunitinib, pazopanib, motesanib, axitinib, retinoic acid, etc. are also gradually being put into clinical trial research.