ECE2023 Poster Presentations Thyroid (163 abstracts)
Redifferentiation with Vemurafenib of BRAF-mutated Radioiodine Refractory Differentiated Metastatic Thyroid Cancer in two patients
Chrysoula Koukoula 1 , Olga Papalou 1 , Aristidis Diamantopoulos 1 , Aikaterini Beka 1 , Dimitra Baikousi 1 , Vasiliki Antonopoulou 1 , Georgia Ntali 1 , Theodora Stratigou 1 , Phoebe Rontogianni 2 , Ioannis Datseris 2 , Dimitra Vassiliadi 1 & Stylianos Tsagarakis 1
1Evangelismos Hospital, Department of Endocrinology Diabetes and Metabolism, National Expertise Center for Rare Endocrine Diseases, Athens, Greece; 2Evangelismos Hospital, Nuclear Medicine and PET/CT Department,, Athens, Greece
Radioiodine treatment is the cornerstone of differentiated thyroid cancer (DTC) management. A number of thyroid cancers, however, become radioiodine-refractory (RAIR) and these represent about 60% of advanced DTCs and are responsible for the vast majority of DTC mortality. RAIR DTC has limited therapeutic options, mainly tyrosine kinase inhibitors that are associated with moderate efficacy and considerable toxicity. Reinducing NIS expression (redifferentiation) with the aim of restoring RAI avidity is a promising strategy. To this end, vemurafenib has been used in small clinical studies of BRAFV600E mutated advanced DTC with encouraging results. Two patients with RAIR, BRAFV600E mutant thyroid cancer received vemurafenib for 4 weeks. They had received a total of 400 mCi and 420 mCi 131I respectively, with their latest post-therapeutic scans being negative and with progression of disease (cervical lymphadenopathy and lung metastases). After 4-week therapy with vemurafenib (960 mg BID), they both exhibited positive WBS scans and subsequently each received 200 mCi 131I treatment. Both post-therapeutic WBS showed significant radioiodine uptake in the cervical neck region, and in one of the patients additional uptake in pulmonary nodules. Regarding thyroglobulin levels a different response pattern was observed in these two patients. Specifically, a significant increase in serum thyroglobulin was observed during redifferentiation treatment in one patient, whereas in the other thyroglobulin levels remained stable. Response to treatment was evaluated with imaging and serum thyroglobulin after 6 months, with both patients exhibiting stable disease, with mixed response in different metastatic areas. Vemurafenib treatment was mainly accompanied by Grade 1 or 2 adverse reactions, involving electrolyte abnormalities, skin manifestations and infections that were completely reversible. Redifferentiation reintroduces RAI in the therapeutic quiver of RAIR DTC with optimistic results avoiding the long-term adverse events of TKIs. More studies are needed to define the place of this approach in the management of advance DTC.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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