Clinical benefit and quality of life during low-dose sorafenib maintenance therapy in radioiodine refractory differentiated thyroid cancer patients: A historical cohort study

Document Type : Original Article

Authors

1 Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Effective management of radioiodine (RAI)-refractory differentiated thyroid cancer is a challenge due to limited treatment options. Multikinase inhibitor therapy including sorafenib has been an optional treatment in recent years. This study aims to compare the clinical benefit rate, progression free survival, and quality of life between patients who received limited dose of sorafenib (200-400 mg per day) as opposed to the control group.
Methods: Twenty-two patients who received sorafenib and twenty-three cases in the control group were studied for two years. Baseline variables were comparable between two subgroups. The results of diagnostic imaging methods were also taken into consideration. Quality of life was measured using the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire.
Results: Based on the RECIST (Response Evaluation Criteria in Solid Tumors) criteria, clinical benefit rate was 77.3% and 47.8% in sorafenib and control subgroups respectively (p value=0.042). The median of progression free survival for the sorafenib subgroup was 24 months and in the control subgroup was 22 months (p value=0.020). In a comparison between two groups regarding their quality of life, all subscales were statistically insignificant between the two groups except for the symptom subscale (p value=0.001).
Conclusion: Low-dose sorafenib maintenance therapy is an effective treatment option in RAI- refractory differentiated thyroid cancer with the main effect of stabilizing the disease. Except for unpleasant but tolerable adverse effects, this treatment has no significant negative influence on the quality of life as far as the physical, role, cognitive, emotional, financial and social functions are concerned.
Keywords: Multikinase inhibitors; Sorafenib; Differentiated thyroid cancer; Radioiodine treatment; Progression free survival

Keywords

Main Subjects

References

  1. Karapanou O, Simeakis G, Vlassopoulou B, Alevizaki M, Saltiki K. Advanced RAI-refractory thyroid cancer: an update on treatment perspectives. Endocr-Relat Cancer. 2022 May 1;29(5):R57-66.
  2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan 1; 26(1):1-33.
  3. Jayarangaiah A, Sidhu G, Brown J, Barrett-Campbell O, Bahtiyar G, Youssef I, Arora S, Skwiersky S, McFarlane SI. Therapeutic options for advanced thyroid cancer. J Clin Endocrinol Metab. 2019; 5(1):26. 
  4. Gupta-Abramson V, Troxel AB, Nellore A, Puttaswamy K, Redlinger M, Ransone K, Mandel SJ, Flaherty KT, Loevner LA, O'Dwyer PJ, Brose MS. Phase II trial of sorafenib in advanced thyroid cancer. Clin Oncol. 2008 Oct 10; 26(29):4714.
  5. Hoftijzer H, Heemstra KA, Morreau H, Stokkel MP, Corssmit EP, Gelderblom H, Weijers K, Pereira AM, Huijberts M, Kapiteijn E, Romijn JA. Beneficial effects of sorafenib on tumor progression, but not on radioiodine uptake, in patients with differentiated thyroid carcinoma. Eur J Endocrinol. 2009 Dec 1; 161(6):923-31.
  6. Cabanillas ME, Waguespack SG, Bronstein Y, Williams MD, Feng L, Hernandez M, Lopez A, Sherman SI, Busaidy NL. Treatment with tyrosine kinase inhibitors for patients with differentiated thyroid cancer: the MD Anderson experience. J Clin Endocrinol Metab. 2010 Jun 1; 95(6):2588-95.
  7. Keefe SM, Troxel AB, Rhee S, Puttaswamy K, O'Dwyer PJ, Loevner LA, Mandel SJ, Brose MS. Phase II trial of sorafenib in patients with advanced thyroid cancer. Clin Oncol. 2011 May 20; 29(15_suppl):5562. 
  8. Schneider TC, Abdulrahman RM, Corssmit EP, Morreau H, Smit JW, Kapiteijn E. Long-term analysis of the efficacy and tolerability of sorafenib in advanced radio-iodine refractory differentiated thyroid carcinoma: final results of a phase II trial. Eur J Endocrinol. 2012 Nov 30; 167(5):643.
  9. Ahmed M, Barbachano Y, Riddell A, Hickey J, Newbold KL, Viros A, Harrington KJ, Marais R, Nutting CM. Analysis of the efficacy and toxicity of sorafenib in thyroid cancer: a phase II study in a UK based population. Eur J Endocrinol. 2011 Aug 1; 165(2):315.
  10. Jean GW, Mani RM, Jaffry A, Khan SA. Toxic effects of sorafenib in patients with differentiated thyroid carcinoma compared with other cancers. JAMA Oncol. 2016 Apr 1;2(4):529-34.
  11. Shen CT, Qiu ZL, Luo QY. Sorafenib in the treatment of radioiodine-refractory differentiated thyroid cancer: a meta-analysis. Endocr Relat Cancer. 2014 Feb 27; 21(2):253-61.
  12. Fugazzola L, Elisei R, Fuhrer D, Jarzab B, Leboulleux S, Newbold K, Smit J. 2019 European Thyroid Association guidelines for the treatment and follow-up of advanced radioiodine-refractory thyroid cancer. Eur Thyroid J. 2019 Oct 1; 8(5):227-45.
  13. Haddad RI, Nasr C, Bischoff L, Busaidy NL, Byrd D, Callender G, Dickson P, Duh QY, Ehya H, Goldner W, Haymart M, Hoh C, Hunt JP, Iagaru A, Kandeel F, Kopp P, Lamonica DM, McIver B, Raeburn CD, Ridge JA, Ringel MD, Scheri RP, Shah JP, Sippel R, Smallridge RC, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Johnson-Chilla A, Hoffmann KG, Gurski LA.  NCCN guidelines insights: thyroid carcinoma, version 2.2018. J Natl Compr Canc Netw. 2018 Dec 1; 16(12):1429-40.
  14. Santos FS, Santos RJ, Leite V. Sorafenib and sunitinib for the treatment of metastatic thyroid cancer of follicular origin: A 7-year single-center experience. Eur Thyroid J. 2019 Oct 1; 8(5):262-7.
  15. Kloos RT, Ringel MD, Knopp MV, Hall NC, King M, Stevens R, Liang J, Wakely PE Jr, Vasko VV, Saji M, Rittenberry J, Wei L, Arbogast D, Collamore M, Wright JJ, Grever M, Shah MH. Phase II trial of sorafenib in metastatic thyroid cancer. Clin Oncol. 2009 Apr 4; 27(10):1675.
  16. Fleeman N, Houten R, Chaplin M, Beale S, Boland A, Dundar Y, Greenhalgh J, Duarte R, Shenoy A. A systematic review of lenvatinib and sorafenib for treating progressive, locally advanced or metastatic, differentiated thyroid cancer after treatment with radioactive iodine. BMC Cancer. 2019 Dec; 19(1):1-16. 
  17. Chen L, Shen Y, Luo Q, Yu Y, Lu H, Zhu R. Response to sorafenib at a low-dose in patients with radioiodine-refractory pulmonary metastases from papillary thyroid carcinoma. Thyroid. 2011 Feb 1; 21(2):119-24.
  18. Dadu R, Waguespack SG, Sherman SI, Hu MI, Busaidy NL, Jimenez C, Habra MA, Ying AK, Bassett RL, Cabanillas ME. Efficacy and tolerability of different starting doses of sorafenib in patients with differentiated thyroid cancer. Oncologist . 2014 May; 19(5):477-82.
  19. Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, De La Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomized, double-blind, phase 3 trial. Lancet. 2014 Jul 26; 384(9940):319-28.
  20. Lin CY, Chang JS, Huang SM, Hung CJ, Hung CL, Chang CT, Yang HR, Hsieh TC, Huang YH, Tsai HJ. Experience of sorafenib treatment in differentiated thyroid cancer from Taiwan. J Formos Med Assoc. 2021 Jan 1; 120(1):189-95.
  21. Nervo A, Ragni A, Piovesan A, Marica V, Migliore E, Gallo M, Arvat E. Quality of life during treatment with lenvatinib for thyroid cancer: The patient’s perspective beyond the medical evaluation. Eur Thyroid J. 2021 Mar 1;10(1):65-71.
  22. Razavi Ratki SK, Fallahi B, Namiranian N, Emami-Ardekani A, Saghari M, Mirabzadeh A, Fard-Esfahani A, Beiki D, Eftekhari M, Pooyafard F. Factors affecting the quality of life of  well-differentiated thyroid carcinoma patients: A cross-sectional study on 435 Iranian patients. Iran J Nucl Med. 2016;24(2):92-8.

Files

Share

How to cite

Statistics