Could thyroid dysfunction influence outcome in sunitinib-treated metastatic renal cell carcinoma?

BACKGROUND

Sunitinib is a standard of care for metastatic renal cell carcinoma (mRCC). Hypothyroidism is frequently observed under sunitinib therapy. This study was conducted to prospectively determine the correlation between thyroid function and progression-free survival (PFS) in this population.

PATIENTS AND METHODS

One hundred and eleven mRCC patients treated with sunitinib were evaluated for serum thyroid-stimulating hormone (TSH) and T4 levels before treatment and every 6 weeks during treatment. Survival was analysed according to a landmark method with a cut-off of 6 months, excluding early progressive or early-censored patients.

RESULTS

Out of the 102 patients with normal baseline thyroid function, 53% developed thyroid dysfunction, including 95% hypothyroidisms out of which 90.9% received L-thyroxine replacement. Median time to TSH alteration was 5.4 months. Median PFS was 11.7 months for the entire population. Median PFS was not different between the groups with abnormal or normal thyroid function after 6 months of treatment (18.9 and 15.9 months, respectively, log-rank P = 0.94, hazard ratio = 1.02, 95% confidence interval = 0.54-1.93). There was no difference even after adjustment for Memorial Sloan-Kettering Cancer Centre classification and therapy line.

CONCLUSIONS

Abnormal thyroid function with hormonal substitution did not increase survival in our population, independent of initial prognosis and previous treatments. Larger comparative studies are deserved to validate these conclusions.

Recurrence of neonatal haemochromatosis in half sibs born of unaffected mothers

We report two families in which neonatal haemochromatosis was observed in half sibs. In the first family, two successive girls were born of different fathers. In the second family, an affected brother and sister were followed by an affected half brother born after donor insemination. These observations, as well as a previous abstract describing two affected half sisters, revive the debate over the inheritance of neonatal haemochromatosis. Incomplete penetrance or gonadal mosaicism for a dominant disorder, a maternal "environmental factor", or mitochondrial defect may be more suitable explanations than autosomal recessive inheritance in this condition. Alternative modes of fertilisation, such as donor insemination or in vitro fertilisation with donor eggs, should be considered with caution.

Clinical experience with a triphasic oral contraceptive ('Trinordiol') in young women

Seven hundred and fifty cycles of treatment with a new triphasic oral contraceptive (WL-49(50). 'Trinordiol') containing the lowest quantity of steroids of all available preparations were evaluated in 75 healthy young women (mean age 19.6 years), 70% of whom had regular, normal cycles. Sixty-five percent had not used contraception before; the others had previously been on combined or progestagen-only oral contraceptives or had an IUD. The mean length of treatment with the triphasic preparation was 10 cycles. No pregnancy was recorded during the 750 cycles of treatment. Fifteen (20%) women dropped out of the study for medical reasons, essentially breast tenderness, weight increase, spotting and nausea, in decreasing order of frequency. Mastalgia was present in 21% of the women (8.9% of the cycles) during triphasic oral contraception, but this symptom disappeared in more than half of the cases within 3 months of continued use. Other side-effects were less frequent: vaginal discharge (4.4% of the cycles), nausea (3.7%), abdominal and leg cramps (2.8%), headaches (3.2%) and weight increase (3%). Spotting and breakthrough bleeding were reported during only 1.9% of the cycles, a remarkably low frequency. No absence of withdrawal bleeding was noted. Weight and blood pressure changes were minimal and never reached statistical significance. Hypertension developed during triphasic medication in 1 predisposed individual. Complaints of oestrogen-related symptoms such as breast tenderness and digestive disorders were probably due to the reduced progestagen content of the preparation compared with combined low fixed daily dose oral contraceptives. However, no increases in dysmenorrhoea and/or premenstrual tension were noted. It is concluded that the triphasic preparation provides effective contraception with excellent cycle control and minimal side-effects, which should help to increase the acceptability of low-dose combined oral contraceptives.

Alteration of free hCG subunits secretions in ectopic pregnancy

Intact hCG and free α and β hCG subunits were simultaneously measured by specific radioimmunoassays in blood samples from pregnant women with normal pregnancy (n = 87; control group) or with a ruptured ectopic pregnancy (n = 35) between 5 and 14 weeks. Since the lower 95% confidence limit of the hCG levels encountered in normal pregnancies was at 1200 ng/ml, the pathological group has been subdivided in 2 subgroups: A (n = 17) if hCG was greater and B (n = 18) if hCG was lower than this limit.

In subgroup A, mean hCG and β hCG were significantly lower than in the control group in contrast to a tendency to secrete and/or release more α hCG, as reflected by a significantly increased ratio of α hCG/hCG. Thus, the ectopically implanted trophoblast, even when able to produce normal amounts of hCG, undergoes an impairment of its ability to synthesize and/or release free β hCG but not free α hCG, of which the synthesis and/or release appears to become even enhanced.

In subgroup B, mean hCG, α hCG and β hCG levels were all dramatically suppressed but there was surprisingly less alteration of the synthesis and/or release of free β hCG.

These alterations of the relative secretions of the free hCG subunits, compared to those occurring for various glycoproteic hormones in pathological circumstances, reflect probably early alterations of the trophoblast.

Serum concentrations of human chorionic gonadotrophin and its alpha and beta subunits. 1. During normal singleton and twin pregnancies

Homologous radioimmunoassays have been developed for native hCG and its alpha and beta subunits. Their specificities were assessed by analysis of the inhibition ca and beta subunits. 1. During normal singleton and twin pregnancies.

[Maternal serum levels of chorionic gonadotropin and its alpha and beta free subunits as a function of the fetal sex. Preliminary study]

The maternal serum levels of hCG and its alpha or beta subunits were measured in 96 normal pregnancies and correlated with the fetal sex. During the first 20 weeks (69 cases), the maternal serum levels of hCG, of its alpha subunit and particularly of its beta subunit were higher in cases of female fetuses. However no statistically significant difference was observed between the levels of hCG or its subunits in serum of pregnancies with male or female fetuses. During the second half of pregnancy, the serum hCG levels were discretely higher in cases with female fetuses (no significant difference) and the serum levels of its alpha or beta subunits were identical in cases of male of female fetuses.