ECE2009 Poster Presentations Clinical case reports and clinical reports (61 abstracts)
Treatment of metastatic medullary thyroid carcinoma with sorafenib
Philippos Kaldrymides 1 , Ifigenia Kostoglou-Athanassiou 1 , Anastasios Goudouvas 1 , Eirini Veniou 1 , Theodosia Bakola 1 , Anastasia Agelopoulou 1 , Dimitrios Thomas 1 & Nikolaos Ziras 2
1Department of Endocrinology, Metaxa Hospital, Preaus, Greece; 2Department of Internal Medicine, Metaxa Hospital, Pireaus, Greece.
Medullary thyroid carcinoma is an uncommon malignancy of hereditary and sporadic presentation. Mutations in the RET-protooncogene are involved in the pathogenesis of >50% of the sporadic cases. Currently, there is no effective treatment for metastatic medullary thyroid carcinoma. The aim was to present a case of metastatic medullary thyroid carcinoma that was treated by the administration of sorafenib, a multiple kinase inhibitor.
A patient, female aged 38 years with no family history of MEN syndrome or familial medullary thyroid cancer, presented with a diffuse enlargement of the thyroid gland. The patient underwent total thyroidectomy and left modified radical neck dissection, revealing a left lobe medullary carcinoma invading the right lobe with transcapsular extension and extensive lymph node invasion. Two years later she presented with persistent disease and underwent a radical neck dissection and neck radiotherapy. Four years later an 111In-octreotide scintigram performed showed signs of possible somatostatin receptor positive lung and bone metastatic disease. Four consecutive doses of 150 mCi 111In-octreotide were administered. Calcitonin levels were 12 851 pg/ml (normal values <13 pg/ml). Two years later she presented with extensive metastatic disease, calcitonin levels being 14 914 pg/ml. She was started on sorafenib 400 mg orally twice daily. A month later calcitonin levels were 7322 pg/ml, 2 months later being 8302 pg/ml. The patient developed a malar rash, malaise and transient diarrhea.
Surgical resection is the mainstay of treatment for medullary thyroid carcinoma. However, once the carcinoma becomes unresectable there is no effective treatment. Easily administered, active and tolerable agents, such as sorafenib, are clinically relevant when they offer disease regression or prolonged disease stabilization. Further studies are needed to examine the effect of sorafenib in metastatic medullary thyroid carcinoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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