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Kobayashi T, Iwama S, Yamagami A, Yasuda Y, Okuji T, Ito M, Zhou X, Ando M, Onoue T, Miyata T, Sugiyama M, Hagiwara D, Suga H, Banno R, Hase T, Morise M, Ito T, Kikumori T, Inoue M, Ando Y, Masuda N, Kawashima H, Hashimoto N, Arima H. Elevated TSH Level, TgAb, and Prior Use of Ramucirumab or TKIs as Risk Factors for Thyroid Dysfunction in PD-L1 Blockade. J Clin Endocrinol Metab 2022; 107:e4115-e4123. [PMID: 35918067 DOI: 10.1210/clinem/dgac467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid dysfunction is frequently caused by treatment with antiprogrammed cell death-1 ligand 1 antibodies (PD-L1-Abs) and anticancer drugs, including ramucirumab (RAM) and multitargeted tyrosine kinase inhibitors (multi-TKIs), which are often used prior to PD-L1-Ab treatment in cancer patients. METHODS A total of 148 patients treated with PD-L1-Abs were evaluated for antithyroid antibodies at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then were observed until the visits stopped. RESULTS Of the 148 patients, 15 (10.1%) developed thyroid dysfunction after PD-L1-Ab treatment (destructive thyroiditis in 8 and hypothyroidism without preceding thyrotoxicosis in 7). The prevalence of an elevated thyroid-stimulating hormone (TSH) level at baseline (3/15 [20.0%] vs 4/133 [3.0%], P < .05), positive antithyroglobulin antibodies (TgAbs) at baseline (4/15 [26.7%] vs 5/133 [3.8%], P < .05) and prior treatment with RAM or multi-TKIs (3/15 [20.0%] vs 5/133 [3.8%], P < .05) were significantly higher in patients with vs without thyroid dysfunction. In a multivariate analysis, elevated TSH level at baseline, TgAb positivity at baseline, and prior treatment with RAM or multi-TKIs were significantly associated with the development of thyroid dysfunction, with ORs of 7.098 (95% CI 1.154-43.638), 11.927 (95% CI 2.526-56.316), and 8.476 (95% CI 1.592-45.115), respectively. CONCLUSION The results of this real-world study suggest that the risk of thyroid dysfunction induced by PD-L1-Abs can be predicted by the TSH level at baseline, TgAb positivity at baseline, and prior treatment with RAM or multi-TKIs.
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Affiliation(s)
- Tomoko Kobayashi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayana Yamagami
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Yasuda
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Okuji
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaaki Ito
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Xin Zhou
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Takeshi Onoue
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Miyata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Sugiyama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Hagiwara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoichi Banno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Tetsunari Hase
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyone Kikumori
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Megumi Inoue
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Jeevan R, Joshi R, Ramesh J. Anaesthetic implications of a case of hyperthyroidism detected during the closure of an atrial septal defect. BMJ Case Rep 2022; 15:e250427. [PMID: 36130820 PMCID: PMC9494558 DOI: 10.1136/bcr-2022-250427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman in her mid-20s who was clinically euthyroid presented with an ostium secondum atrial septal defect for closure. Preoperatively, heart rate ranged from 80 to 110 beats per minute. On the day of surgery, heart rate was 120 beats per minute, which settled after induction. During ultrasound guided central line access, a thyroid swelling was noticed. 20-30 min after commencement of the surgery, heart rate increased up to 130 beats per minute. Since other causes of tachycardia was ruled out, an intraoperative blood sample for thyroid function test was sent. Esmolol was kept ready in case the swelling turned out to be hyperfunctioning thyroid nodule. Post bypass, the patient again developed tachycardia. The thyroid function test showed elevated T3, T4 and a mildly elevated TSH (Thyroid stimulating hormone) value, consistent with an extrathyroid source. The patient is on long-term follow-up under an endocrinologist. Postoperatively, she is again euthyroid and heart rates have settled to less than 100 beats per minute.
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Affiliation(s)
- Ram Jeevan
- Anesthesiology, Saveetha University Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Reesha Joshi
- Anesthesiology, Saveetha University Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Jayashree Ramesh
- Anesthesiology, Saveetha University Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
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Basolo A, Matrone A, Elisei R, Santini F. Effects of tyrosine kinase inhibitors on thyroid function and thyroid hormone metabolism. Semin Cancer Biol 2021; 79:197-202. [PMID: 33476722 DOI: 10.1016/j.semcancer.2020.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
The increasing knowledge of the molecular mechanisms in the cell signaling pathways of malignant cells, has recently led to the discovery of several tyrosine kinases (TKs), mainly TK receptors (TKR), which play a major role in the pathogenesis of many types of cancer. These receptors, physiologically involved in cell growth and angiogenesis, may harbor mutations or be overexpressed in malignant cells, and represent a target for anticancer therapy. Indeed, several therapeutic agents targeting specific altered pathways such as RET, BRAF, RAS, EGFR and VEGFR, have been identified. Tyrosine kinase inhibitors (TKIs) affect TK dependent oncogenic pathways by competing with ATP binding sites of the TK domain, thus blocking the activity of the enzyme, and thereby inhibiting the growth and spread of several cancers. Although the therapeutic action may be very effective, these molecules, due to their mechanism of multitargeted inhibition, may produce adverse events involving several biological systems. Both hypothyroidism and thyrotoxicosis have been reported during treatment with TKI, as well as an effect on the activity of enzymes involved in thyroid hormone metabolism. The pathogenic mechanisms leading to thyroid dysfunction and changes in serum thyroid function tests occurring in patients on TKI are reviewed and discussed in this manuscript.
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Affiliation(s)
- Alessio Basolo
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Destructive thyroiditis presenting as thyrotoxicosis followed by hypothyroidism during lenvatinib therapy for hepatocellular carcinoma. Clin J Gastroenterol 2020; 13:860-866. [PMID: 32128670 DOI: 10.1007/s12328-020-01107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/16/2020] [Indexed: 02/08/2023]
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5
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Koizumi Y, Hirooka M, Hiraoka A, Ochi H, Tanaka T, Yukimoto A, Imai Y, Watanabe T, Yoshida O, Miyake T, Matsuura B, Michitaka K, Joko K, Abe M, Hiasa Y. Lenvatinib-induced thyroid abnormalities in unresectable hepatocellular carcinoma. Endocr J 2019; 66:787-792. [PMID: 31142692 DOI: 10.1507/endocrj.ej19-0140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lenvatinib has anti-tumor activity against advanced hepatocellular carcinoma (HCC). Hypothyroidism is also a frequent complication in patients treated with lenvatinib. However, studies on lenvatinib-induced thyroid toxicity and destructive thyroiditis are limited. Therefore, this study aimed to clarify the frequency and timing of thyroid abnormalities in lenvatinib for unresectable HCC. This retrospective study enrolled 50 patients with advanced HCC treated with lenvatinib. Patients were classified to have euthyroid, subclinical hypothyroidism, overt hypothyroidism, and thyrotoxicosis. The timing of thyroid dysfunction was assessed, and risk factors for incident hypothyroidism or thyrotoxicosis were evaluated using multivariate models. Subclinical hypothyroidism, overt hypothyroidism, and thyrotoxicosis occurred in 7 (14.0%), 26 (52.0%), and 5 (10.0%) patients, respectively. In the 33 patients with hypothyroidism, 27 (84.4%) developed the condition within 2 weeks of starting lenvatinib treatment. Of the 5 patients with thyrotoxicosis, 3 developed the condition within 8 weeks of starting lenvatinib administration. One patient developed thyrotoxicosis in only 1 week of the initiation of treatment. No correlation between the presence of antibodies and the incidence and severity of thyroid dysfunction due to the autoimmune mechanism was observed. The progression-free survival was significantly better in the hypothyroidism group. Lenvatinib treatment for unresectable HCC not only causes hypothyroidism, but also thyrotoxicosis. Moreover, these thyroid conditions develop within the early period of treatment at a higher prevalence. Patients with thyroid dysfunction had better prognosis. Based on these results, in patients administered with lenvatinib, there is need for careful assessment for the possibility of thyroid dysfunction from the onset of treatment.
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Affiliation(s)
- Yohei Koizumi
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masashi Hirooka
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hironori Ochi
- Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Takaaki Tanaka
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Atsushi Yukimoto
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yuusuke Imai
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takao Watanabe
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Osamu Yoshida
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Teruki Miyake
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Bunzo Matsuura
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Masanori Abe
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoichi Hiasa
- Departments of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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Balzhanova YB, Parovichnikova EN, Sokolov AN, Ryzhko VV, Samtsova MA, Gribanova EO. [Sorafenib - induced thyroiditis in patient with a relapse of acute myelomonocytic leukemia with FLT3-ITD mutation]. TERAPEVT ARKH 2019; 91:93-97. [PMID: 32598759 DOI: 10.26442/00403660.2019.08.000381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Sorafenib has been used in acute myeloid leukemias with FLT3-ITD mutation improving the outcomes. However the high incidence of treatment - emergent adverse event may be associated with treatment using sorafenib with cytotoxic chemotherapy. We have reported a case of severe thyroiditis in patient with a relapse of acute myelomonocytic leukemia.
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Hirooka M, Ochi H, Hiraoka A, Koizumi Y, Matsuura B, Joko K, Michitaka K, Abe M, Hiasa Y. Destructive Thyroiditis Induced by Lenvatinib in Three Patients with Hepatocellular Carcinoma. Intern Med 2019; 58:791-795. [PMID: 30333428 PMCID: PMC6465025 DOI: 10.2169/internalmedicine.1874-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hypothyroidism is a frequently occurring complication in patients on lenvatinib treatment. However, little is known about lenvatinib-induced thyrotoxicosis and destructive thyroiditis. We herein report the cases of three patients who developed hyperthyroidism during the course of lenvatinib treatment. All patients had multiple hepatocellular carcinoma of Child-Pugh class A. Two patients required beta blockers for the management of palpitations. One patient developed hyperthyroidism only one week after the initiation of lenvatinib treatment. Thus, the possibility of hyperthyroidism developing within one week after the first administration should be kept in mind, and periodic surveillance of the thyroid function should be performed during the early period of lenvatinib therapy (within the first two weeks or so after the initial administration).
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Hironori Ochi
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Bunzo Matsuura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
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8
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Sorafenib-induced Prostate Volume Reduction, a New Adverse Effect Detected by Imaging: A Pilot Study. J Belg Soc Radiol 2018; 102:69. [PMID: 30386849 PMCID: PMC6208293 DOI: 10.5334/jbsr.1607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Sorafenib has been used in the treatment of advanced hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC). Sorafenib-associated organ reduction have been reported on imaging, such as thyroid, pancreas and muscle, but there has been no research on prostate volume reduction (PVR). Methods We retrospectively analyzed 26 patients (twenty with HCC and six patients with RCC) who underwent sorafenib therapy for 31 to 1225 days (median, 100 days). PVR was estimated by two independent readers using CT volumetry. Results The sum of all prostate volumes measured by reader 1 was 24.2 ± 13.8 cm3 on the baseline CT and 20.4 ± 10.6 cm3 on the follow-up CT (p < 0.001), and that measured by reader 2 was 22.3 ± 13.9 cm3 on the baseline CT and 19.2 ± 10.6 cm3 on the follow-up CT (p < 0.001). The concordance correlation coefficient for the prostate volume measured by the two readers was 0.95 on the baseline CT scans and 0.94 on the follow-up CT scans. Sorafenib-associated PVR demonstrated slight dependence to the exposure time (r = -0.23). One patient with benign prostatic hyperplasia (BPH) showed PVR (from 80.4 to 61.5 cm3 [reader 1]; 83.4 to 61.6 cm3 [reader 2]) after sorafenib administration. Sorafenib-associated PVR occurred in patients both with and without underlying liver dysfunction with relative prostate volume changes of 86.7 ± 12.0% and 85.0 ± 9.0%, respectively. Conclusion Our study demonstrated significant PVR with sorafenib treatment in patients regardless of the presence of BPH and underlying liver dysfunction.
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Nomoto H, Miyoshi H, Sekizaki T, Atsumi T. Comment on "Elevation of Serum Carcinoembryonic Antigen Concentration Caused by Everolimus-Induced Lung Injury: A Case Report". Ann Thorac Cardiovasc Surg 2018; 24:165-166. [PMID: 29553086 PMCID: PMC6033523 DOI: 10.5761/atcs.lte.18-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hiroshi Nomoto
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomonori Sekizaki
- Department of Diabetes and Lipid Metabolism Internal Medicine, Hokkaido Medical Center, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Beukhof CM, van Doorn L, Visser TJ, Bins S, Visser WE, van Heerebeek R, van Kemenade FJ, de Rijke YB, de Herder WW, Chaker L, Mathijssen RH, Peeters RP. Sorafenib-Induced Changes in Thyroid Hormone Levels in Patients Treated for Hepatocellular Carcinoma. J Clin Endocrinol Metab 2017; 102:2922-2929. [PMID: 28575418 DOI: 10.1210/jc.2016-4025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/22/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT The pathogenesis of tyrosine kinase inhibitor-induced thyroid hormone (TH) alterations are still a matter of debate. OBJECTIVE The objective of this study was to determine the effects of sorafenib on TH levels in patients with hepatocellular carcinoma (HCC) and to evaluate possible mechanisms. DESIGN We performed a prospective cohort study between 2009 and 2016. SETTING This study was conducted at a tertiary referral center. PATIENTS This study included 57 consecutive patients with HCC who were treated with sorafenib. MAIN OUTCOME MEASURE Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were measured every 6 weeks, and extensive thyroid function tests (TFTs) were measured before treatment (t0), after 6 weeks (t6), and at the end of therapy. The effect of sorafenib on TH transport by monocarboxylate transporter (MCT)8 or MCT10 was tested in transfected COS1 cells. RESULTS Four patients (7%) developed thyroiditis. Among the other patients, 30% had elevation of TSH or FT4 above the normal range. Overall, between t0 and t6, mean TSH increased from 1.28 to 1.57 mU/L (P < 0.001) and mean FT4 from 18.4 to 21.2 pmol/L (P < 0.001). Simultaneously, the serum triiodothyronine (T3)/reverse triiodothyronine ratio and the (T3/thyroxine) ×100 ratio decreased. Sorafenib decreased cellular T3 uptake by MCT8 and to a lesser extent by MCT10. CONCLUSIONS These in vivo data suggest that sorafenib affects TFTs on multiple levels. Our in vitro experiments suggest a possible role of sorafenib-induced inhibition of T3 transport into the cell by MCT8 and MCT10.
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Affiliation(s)
- Carolien M Beukhof
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Leni van Doorn
- Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Sander Bins
- Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Ramona van Heerebeek
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Ron H Mathijssen
- Erasmus MC Cancer Institute, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, Netherlands
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Takahashi H, Nasu K, Minami M, Kojima T, Nishiyama H, Ishiguro T, Konishi T. Organ Atrophy Induced by Sorafenib and Sunitinib - Quantitative Computed Tomography (CT) Evaluation of the Pancreas, Thyroid Gland and Spleen. Pol J Radiol 2016; 81:557-565. [PMID: 27956943 PMCID: PMC5129701 DOI: 10.12659/pjr.898936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate organ atrophy induced by sorafenib and sunitinib, we retrospectively reviewed the CT scans of renal cell carcinoma (RCC) patients receiving molecular targeted therapy (MTT) using sorafenib or sunitinib, and performed volumetric analysis of the pancreas, thyroid gland, and spleen. Material/Methods Thirteen RCC patients receiving MTT were assigned as the evaluation cases (MTT group), while thirteen additional RCC patients not receiving MTT were retrieved as the Control group. We evaluated the baseline and follow-up CT studies. The volume of the three organs estimated by CT volumetry was compared between the baseline and follow-up CTs. The atrophic ratio of the organ volume in the follow-up CT to that in the baseline CT was calculated, and compared between the MTT and Control groups. Results All measured organs in the MTT group showed statistically significant volume loss, while no significant change was observed in the Control group. Mean atrophic ratio in the MTT group was 0.74, 0.58, and 0.82 for the pancreas, thyroid and spleen, respectively. The differences in atrophic ratios between both groups were all statistically significant (P<0.05). Conclusions Single-agent sorafenib or sunitinib therapy induced statistically significant atrophy in the pancreas, thyroid, and spleen.
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Affiliation(s)
- Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Katsuhiro Nasu
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Manabu Minami
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Toshitaka Ishiguro
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Takahiro Konishi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1283] [Impact Index Per Article: 160.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
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Eroukhmanoff J, Castinetti F, Penel N, Salas S. Auto-immune thyroid dysfunction induced by tyrosine kinase inhibitors in a patient with recurrent chordoma. BMC Cancer 2016; 16:679. [PMID: 27558389 PMCID: PMC4997685 DOI: 10.1186/s12885-016-2705-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/10/2016] [Indexed: 11/28/2022] Open
Abstract
Background While hypothyroidism has frequently been reported with the use of TKIs, the thyroid-stimulating hormone (TSH) suppressing effect of TKIs is rare, except for thyroiditis. We describe a case with progressive recurrent chordoma who initially became hyperthyroid in a context of autoimmunity under sorafenib treatment and later under imatinib treatment. Case presentation A 57-year-old man with lumbar chordoma began daily treatment of 800 mg sorafenib. He did not have any other medication or recent iodinated-contrast exposure and his family history was negative for thyroid and autoimmune disease. There was no history of neck pain, irradiation or trauma, recent fever or viral illness. Pre-treatment TSH was normal. After 18 weeks of treatment, the patient presented hyperthyroidism with positive anti-TSH receptor antibodies. More surprisingly, Graves’ disease recurred during treatment with imatinib. Conclusion The fact that Graves’ disease occurred after two different TKIs suggests that it could be a rare but important class effect. Anti-TSH receptor antibodies should be systematically measured when TSH decreases in order to avoid the erroneous diagnosis of transient hyperthyroidism due to thyroiditis.
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Affiliation(s)
- Juliette Eroukhmanoff
- Department of Medicine, Division of endocrinology, APHM, Conception Hospital, Marseille, France.
| | - Frederic Castinetti
- Department of Medicine, Division of endocrinology, APHM, Conception Hospital, Marseille, France
| | - Nicolas Penel
- Department of Medicine, Division of adult oncology, Oscar Lambret Institute, Lille, France
| | - Sebastien Salas
- Aix Marseille Univ, INSERM, U911, Marseille, France.,Department of Medicine, Division of adult oncology, APHM, Timone Hospital, Marseille, France
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Phillip V, Zahel T, Bärtl K, Rasch S, Ebert O, Schmid RM, Rummeny E, Algül H. Influence of Sorafenib and Bevacizumab on pancreatic volume - A monocentric CT based analysis. Pancreatology 2016; 16:621-4. [PMID: 26968257 DOI: 10.1016/j.pan.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Angiogenesis plays a central role in tumor growth and metastasis and tyrosine kinases are crucial in the modulation of growth factor signaling. Several side effects of tyrosine kinase inhibitors have been reported, including diarrhea due to pancreatic insufficiency. The suspected mechanism is the anti-angiogenetic effect of the inhibited vascular endothelial growth factor (VEGF) causing a disturbance of the microvasculation. The aim of the present study was to determine the volume of the pancreas before and after a therapy both with the multi-tyrosine kinase inhibitor Sorafenib and Bevacizumab, which is a humanized monoclonal immunoglobulin G1 antibody against VEGF. METHODS Retrospective monocentric study including 42 patients who received either Sorafenib, Bevacizumab combined with Flourouracil and/or Irinotecan, or singly Flourouracil and Irinotecan for different non-pancreatic malignancies. The volume of the pancreas was measured before and after therapy by CT-scan based volumetry. RESULTS The pancreatic volume was statistically significantly lower after treatment with Sorafenib (75.4 mL vs. 71.0 mL; p = 0.006) or Bevacizumab and Fluorouracil ± Irinotecan (71.8 mL vs. 62.6 mL; p = 0.020). The pancreatic volume did not change statistically significantly after treatment with Fluorouracil ± Irinotecan only (51.1 mL vs. 49.9 mL; p = 0.142). CONCLUSIONS Pancreatic volume decreases statistically significantly under treatment with both the multi-tyrosine kinase inhibitor Sorafenib and the angiogenesis inhibitor Bevacizumab. This volume reduction is most likely due to a reduced microvasculation by inhibition of VEGF.
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Affiliation(s)
- Veit Phillip
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Tina Zahel
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Klaus Bärtl
- Chirurgische Abteilung, Kreisklinik Wolfratshausen, Moosbauerweg 5, 82515 Wolfratshausen, Germany
| | - Sebastian Rasch
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Oliver Ebert
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Roland M Schmid
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Ernst Rummeny
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany
| | - Hana Algül
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany.
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15
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Ganten MK, Schuessler M, Bruckner T, Ganten TM, Koschny R. Pancreatic Atrophy in Hepatocellular Carcinoma Patients Receiving Long-Term Treatment with Sorafenib. Oncology 2015; 89:88-94. [PMID: 25871578 DOI: 10.1159/000377681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To date, sorafenib is the only approved systemic therapy for advanced hepatocellular carcinoma (HCC). Pancreatic atrophy has recently been reported in 2 patients as a novel side effect after long-term sorafenib treatment. METHODS We retrospectively analyzed clinical and radiological data of patients with advanced HCC with long-term treatment of sorafenib (median 279 days, range 153-826 days). Pancreata were semi-manually segmented section by section to calculate the pancreas volumes before and under sorafenib treatment. RESULTS Sorafenib reduced pancreatic volume in 18/19 (95%) HCC patients with a mean pancreatic volume loss of 25% (p = 0.002). Pancreatic volume loss depended on the dose (r = 0.36) and exposure time of sorafenib (r = 0.35) and was detectable as early as after 3 months of sorafenib treatment and already after a cumulative sorafenib dose of <100 g. Median overall survival was 13.2 months (range 7.8-31.3 months) but did not correlate with sorafenib-induced pancreatic volume reduction (hazard ratio 1.002, 95% confidence interval 0.981-1.060, p = 0.24). CONCLUSION We could confirm pancreatic atrophy as a novel adverse event of sorafenib therapy in HCC patients, correlating with sorafenib dose and exposure time.
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Affiliation(s)
- Maria-Katharina Ganten
- Departments of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
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Krajewska J, Handkiewicz-Junak D, Jarzab B. Sorafenib for the treatment of thyroid cancer: an updated review. Expert Opin Pharmacother 2015; 16:573-83. [PMID: 25605317 DOI: 10.1517/14656566.2015.1005601] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sorafenib (Nexavar) is an oral multi-kinase inhibitor targeting B-type Raf kinase (BRAF) (both wild type and BRAF(V600E)), VEGFR1, VEGFR2, VEGFR3, PDGFRβ and RET (also RET/PTC) influencing both differentiated thyroid cancer (DTC) cell proliferation and angiogenesis. AREAS COVERED Encouraging results achieved in numerous Phase II trials were confirmed in a Phase III study conducted in radioiodine-refractory DTC. Sorafenib compared to placebo significantly prolongs progression-free survival, 10.8 versus 5.8 months, respectively. However, its administration resulted mainly in disease stabilization. No complete remission was obtained in any study. Beneficial effects were also demonstrated for medullary and anaplastic thyroid cancer; however further studies fulfilling evidence based medicine criteria are necessary. Its toxicity profile is convergent with other VEGFR inhibitors. The most common treatment-related side-effects involve skin toxicity (predominantly hand-foot skin reaction, different rashes and alopecia), gastrointestinal disturbances (diarrhea, abdominal pain), constitutional adverse reactions (anorexia, weight loss, fatigue) and hypertension. Although most adverse reactions are manageable, > 50% of patients required dose reduction. EXPERT OPINION Sorafenib constitutes the first line treatment option in advanced, radioiodine-refractory DTC. However, there are still no data on its efficacy in patients progressed after another tyrosine kinase inhibitor. Other applications of the drug, such as use as adjuvant therapy to 131-I treatment, requires further studies.
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Affiliation(s)
- Jolanta Krajewska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Nuclear Medicine and Endocrine Oncology Department, Gliwice Branch , Gliwice , Poland + 48 32 2789301 ; +48 32 2789310 ;
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Illouz F, Braun D, Briet C, Schweizer U, Rodien P. Endocrine side-effects of anti-cancer drugs: thyroid effects of tyrosine kinase inhibitors. Eur J Endocrinol 2014; 171:R91-9. [PMID: 24833135 DOI: 10.1530/eje-14-0198] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are currently used by most oncologists. Among their side effects, thyroid dysfunctions are nowadays clearly observed. Whereas changes in thyroid function tests have been originally described with sunitinib, we now know that many TKIs can induce hypothyroidism and hyperthyroidism. In this study, the various molecules implicated in thyroid dysfunctions are analysed and the latest data on physiopathological mechanisms are approached in order to propose a strategy of thyroid monitoring of patients on TKI therapy.
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Affiliation(s)
- Frédéric Illouz
- Département d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, FranceDépartement d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, France
| | - Doreen Braun
- Département d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, France
| | - Claire Briet
- Département d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, France
| | - Ulrich Schweizer
- Département d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, France
| | - Patrice Rodien
- Département d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, FranceDépartement d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, FranceDépartement d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universität Bonn, D-53115 Bonn, GermanyHôpitaux Universitaires Paris-SudHôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre F-94275, FranceINSERMU1083, Angers Cedex 09 F-49933, FranceUniversité d'AngersAngers Cedex 09 F-49933, FranceDépartement d'Endocrinologie Diabétologie NutritionCHU d'Angers, Angers Cedex 09 F-49933, FranceCentre de Référence des Pathologies de la Réceptivité HormonaleCHU d'Angers, Angers Cedex 09 F-49933, FranceInstitut für Biochemie und MolekularbiologieRheinische Friedrich-Wilhelms-Universi
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Yavuz S, Apolo AB, Kummar S, del Rivero J, Madan RA, Shawker T, Reynolds J, Celi FS. Cabozantinib-induced thyroid dysfunction: a review of two ongoing trials for metastatic bladder cancer and sarcoma. Thyroid 2014; 24:1223-31. [PMID: 24724719 PMCID: PMC4106376 DOI: 10.1089/thy.2013.0621] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid dysfunction is a common adverse event associated with tyrosine kinase inhibitors (TKI), but its underlying pathophysiology is unclear. Cabozantinib is a novel TKI currently Food and Drug Administration approved for advanced medullary thyroid cancer and tested in clinical trials on solid tumors including prostate, liver, bladder, breast, and ovarian cancer. METHODS We analyzed the thyroid function of patients enrolled in two phase 2 clinical trials using cabozantinib at the National Institutes of Health Clinical Center. Two cases of thyroiditis associated with cabozantinib therapy are presented in detail, and a systematic review of the literature on TKI-associated thyroid dysfunction is also discussed. RESULTS Between September 2012 and September 2013, 33 patients were treated with cabozantinib, and follow-up thyroid function tests were available for 31 (20 males, 11 females; age 59±1 years). Thyroid dysfunction was recorded in the majority of patients (93.1%), with a predominance of subclinical hypothyroidism. Two cases showed a biphasic pattern of thyroid dysfunction characterized by a transient thyrotoxicosis followed by hypothyroidism. Color Doppler demonstrated an increase in vascularization during the thyrotoxic phase, but no uptake was visualized on nuclear medicine imaging. A systematic review of the literature resulted in the identification of 40 original manuscripts, of which 13 were case series and 6 were case reports describing TKI-associated thyroid dysfunction. CONCLUSION TKI therapy often results in clinically significant thyroid dysfunction. Cabozantinib treatment commonly results in thyroid dysfunction varying from subclinical hypothyroidism to symptomatic thyrotoxicosis. Early detection and characterization of cabozantinib-associated thyroid dysfunction and close follow-up are essential to provide adequate management of this common adverse event.
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Affiliation(s)
- Sahzene Yavuz
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine, and Obesity Branch, National Institutes of Health, Bethesda, Maryland
| | - Andrea B. Apolo
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Shivaani Kummar
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jaydira del Rivero
- National Institutes of Child Health Development, National Institutes of Health, Bethesda, Maryland
| | - Ravi A. Madan
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas Shawker
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - James Reynolds
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Francesco S. Celi
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine, and Obesity Branch, National Institutes of Health, Bethesda, Maryland
- Division of Endocrinology and Metabolism, Virginia Commonwealth University, Richmond, Virginia
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Fallahi P, Ferrari SM, Vita R, Di Domenicantonio A, Corrado A, Benvenga S, Antonelli A. Thyroid dysfunctions induced by tyrosine kinase inhibitors. Expert Opin Drug Saf 2014; 13:723-33. [PMID: 24821006 DOI: 10.1517/14740338.2014.913021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Recently, tyrosine kinase inhibitors (TKIs) have emerged as a new class of anticancer therapy. Although generally considered less toxic than cytotoxic chemotherapy, TKIs do cause significant side effects including fatigue and hypertension. In addition, thyroid dysfunction is a well-known adverse effect of TKI. AREAS COVERED This review provides a comprehensive assessment of TKI-induced thyroid dysfunctions by sunitinib, sorafenib, pazopanib, imatinib, dasatinib, nilotinib, vandetanib, axitinib, motesanib and tivozanib. Furthermore, the potential mechanisms that result in this toxicity, the clinical impact of thyroid dysfunction in these patients and the controversies regarding treatment with thyroid hormone (TH) therapy are evaluated. EXPERT OPINION Detection of TKI-induced thyroid dysfunction requires routine monitoring of thyroid function and may necessitate treatment. Potential benefits in developing thyroid dysfunction and potential harm in treating it necessitate controlled studies. Finally, if treatment is pursued, appropriate dosing and timing of TH replacement will require prospective clinical evaluation.
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Affiliation(s)
- Poupak Fallahi
- University of Pisa, Department of Clinical and Experimental Medicine , Via Savi 10, 56126, Pisa , Italy
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Fatourechi MM, Fatourechi V. An update on subclinical hypothyroidism and subclinical hyperthyroidism. Expert Rev Endocrinol Metab 2014; 9:137-151. [PMID: 30743756 DOI: 10.1586/17446651.2014.887433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Subclinical thyroid dysfunction is characterized by normal levels of peripheral thyroid hormone, paired with a TSH level that is either lower than (subclinical hyperthyroidism) or higher than (subclinical hypothyroidism) the normal laboratory reference range. Slight shifts in peripheral hormone levels result in significant serum TSH changes. The exact upper limit of normal TSH and the management of subclinical hypothyroidism are still controversial. For those with TSH between high upper limit of normal and 10 mIU/L, the authors suggest selective use of thyroxine therapy. The authors agree with the general consensus in favor of therapy for those with serum TSH levels above 10 mIU/L. This recommendation is compatible with guidelines of American Thyroid Association and American Association of Clinical Endocrinologists. For subclinical hyperthyroidism persistent serum TSH <0.1 mIU/L should be treated particularly if the etiology is nodular toxic goiter. For serum TSH between 0.1 mIU/L and lower limit of normal, serum TSH co-morbidities such as cardiac risk factors and osteoporosis may favor therapy.
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Affiliation(s)
| | - Vahab Fatourechi
- b Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Abstract
BACKGROUND Immunotherapies and targeted therapies are frequently associated with thyroid dysfunction, which is in contrast with the rare thyroid abnormalities induced by cytotoxic agents. Immunotherapy with NY-ESO-1, a tumor-associated antigen expressed by a number of malignancies, was reported to trigger hyperthyroidism or hypothyroidism in two HLA-A2 patients with ovarian cancer. We describe now a case of Graves' disease triggered by NY-ESO-1 in a HLA-A2-negative woman. PATIENT FINDINGS A 32-year-old woman with a synovial sarcoma received radiotherapy, chemotherapy, and finally NY-ESO-1 vaccine. The patient was found to have HLA A11/A33(19), B13/B56(22), Cw3/-. One month after the beginning of immunotherapy, thyroid dysfunction was clinically suspected and Graves' disease was biochemically confirmed. Fearful of the antithyroid drugs' side effects, the patient was treated with a beta-blocker (propranolol, 80-20 mg/day). As hyperthyroidism progressively worsened, the patient underwent total thyroidectomy. We hypothesized that NY-ESO-1 shared partial homology with thyroid autoantigens (the so-called molecular mimicry mechanism) and that at least one pair of homologous sequences contained amino acid sequence binding motifs to a restricted number of HLA molecules. We used BLAST software to search amino acid sequence homologies between NY-ESO-1 and thyroid autoantigens (thyrotropin receptor [TSH-R], thyroperoxidase, and thyroglobulin), and the HLA ligand/motif database to look for HLA/T-cell receptor binding motifs in the regions of NY-ESO-1 and thyroid autoantigens that were homologous. We found 15 epitopic regions of NY-ESO-1 homologous to 15 regions of thyroid autoantigens, some of which epitopic: 5 of TSH-R, 8 of thyroglobulin, and 2 of thyroperoxidase. These homologous sequences contain binding motifs belonging to several HLA class I antigens, including HLA A2 and the patient's A11 and A33. SUMMARY Genetically predisposed patients who receive NY-ESO-1 vaccination are at risk to develop thyroid dysfunction. CONCLUSIONS Considering the increasing use of NY-ESO-1, thyroid dysfunctions induced by NY-ESO-1 are expected to increase in cancer patients over the next years.
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Affiliation(s)
- Roberto Vita
- Section of Endocrinology, University of Messina, Messina, Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical & Experimental Medicine, University of Messina, Messina, Italy
| | - Ravin Agah
- Internal Medicine, Palo Alto Medical Foundation, Mountain View, California
| | - Salvatore Benvenga
- Section of Endocrinology, University of Messina, Messina, Italy
- Section of Master's Program on Childhood, Adolescence & Women's Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, A.O.U. Policlinico G. Martino, Messina, Italy
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Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment. BIOMED RESEARCH INTERNATIONAL 2013; 2013:725410. [PMID: 24282820 PMCID: PMC3824811 DOI: 10.1155/2013/725410] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/06/2013] [Accepted: 09/08/2013] [Indexed: 01/07/2023]
Abstract
Tyrosine kinase inhibitors (TKI) belong to a new class of molecular multitargeted anticancer therapy which targets different growth factor receptors and hence attenuates cancer cell survival and growth. Since their introduction as adjunct treatment for renal cell carcinoma and gastrointestinal stromal tumors (GIST), a number of reports have demonstrated that TKI can induce thyroid dysfunction which was especially more common with sunitinib maleate. Many mechanisms with respect to this adverse effect of tyrosine kinase inhibitors have been proposed including their induction of thyroiditis, capillary regression in the thyroid gland, antithyroid peroxidase antibody production, and their ability to decrease iodine uptake by the thyroid gland. Of interest is the observation that TKI-induced thyroid dysfunction may actually be protective as it was shown to improve overall survival, and it was suggested that it may have a prognostic value. Followup on thyroid function tests while patients are maintained on tyrosine kinase inhibitor is strongly recommended. When thyroid dysfunction occurs, appropriate treatment should be individualized depending on patients symptoms and thyroid stimulating hormone level.
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Haraldsdottir S, Li Q, Villalona-Calero MA, Olencki TE, Kendra K, Ing SW. Case of Sorafenib-Induced Thyroid Storm. J Clin Oncol 2013; 31:e262-4. [DOI: 10.1200/jco.2012.46.7142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Quan Li
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Kari Kendra
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Steven W. Ing
- The Ohio State University Medical Center, Columbus, OH
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Clemons J, Gao D, Naam M, Breaker K, Garfield D, Flaig TW. Thyroid dysfunction in patients treated with sunitinib or sorafenib. Clin Genitourin Cancer 2012; 10:225-31. [PMID: 23017335 DOI: 10.1016/j.clgc.2012.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/29/2012] [Accepted: 08/16/2012] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Sunitinib and sorafenib are tyrosine kinase inhibitors used in metastatic renal cell carcinoma and are known to cause hypothyroidism in a subset of patients. The goal of this study was to better characterize the development of hypothyroidism in patients and to examine its relationship to progression-free survival. PATIENTS AND METHODS A retrospective chart review was performed on patients treated with sunitinib or sorafenib from January 1, 2005, to January 1, 2011. Data pertaining to the treatment course and development of hypothyroidism were extracted. Patients with hypothyroidism at the beginning of treatment were analyzed separately. RESULTS A total of 73 treatment periods had sufficient data to analyze. Among patients with normal baseline thyroid function, 15 (44%) of 34 patients treated with sunitinib and 6 (27%) of 22 patients treated with sorafenib developed hypothyroidism. The hazard ratio for the development of hypothyroidism with sorafenib vs. sunitinib treatment was significant, at 0.38 (95% CI, 0.14-0.97). There was a statistically significant difference in the progression-free survival between patients who developed hypothyroidism while receiving treatment compared with those who did not, 18.2 vs. 10.1 months (P = .01). CONCLUSIONS This study demonstrated a significant difference in the incidence of hypothyroidism during treatment with sunitinib and sorafenib, with a higher incidence of hypothyroidism in patients treated with sunitinib. The development of hypothyroidism was associated with a longer progression-free survival.
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Affiliation(s)
- Julia Clemons
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, USA.
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Aihara Y, Yoshiji H, Yamazaki M, Ikenaka Y, Noguchi R, Morioka C, Kaji K, Tastumi H, Nakanishi K, Nakamura M, Yamao J, Toyohara M, Mitoro A, Sawai M, Yoshida M, Fujimoto M, Uemura M, Fukui H. A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma. World J Gastrointest Oncol 2012; 4:115-8. [PMID: 22645635 PMCID: PMC3360105 DOI: 10.4251/wjgo.v4.i5.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 02/14/2012] [Accepted: 02/20/2012] [Indexed: 02/05/2023] Open
Abstract
Sorafenib, a multikinase inhibitor, is the first and only drug, which improves significantly the overall survival in patients with advanced hepatocellular carcinoma (HCC). However, many patients experience diverse side effects, some of them severe and unexpected. To date, acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib. Here, we report the case of a 43-year-old woman with hepatitis C virus-related advanced HCC. She received sorafenib, and later complained of a sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense. Laboratory examination showed mild elevation of transaminases, biliary enzymes, bilirubin, inflammation markers, and a marked peripheral eosinophilia. Abdominal computed tomography (CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris. Consequently, sorafenib treatment was stopped immediately, and steroid-pulse therapy was performed. Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings, eosinophilia, and liver functions. In summary, we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.
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Affiliation(s)
- Yosuke Aihara
- Yosuke Aihara, Hitoshi Yoshiji, Masaharu Yamazaki, Yasuhide Ikenaka, Ryuichi Noguchi, Chie Morioka, Kosuke Kaji, Haruki Tastumi, Keisuke Nakanishi, Maiko Nakamura, Junichi Yamao, Masahisa Toyohara, Akira Mitoro, Masayoshi Sawai, Motoyuki Yoshida, Masao Fujimoto, Masahito Uemura, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, Nara 634-8522, Japan
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