Although the prognosis of thyroid cancer is in general quite favorable when standard management paradigms are applied, some patients do much less well. Radioactive iodine refractory, recurrent or metastatic disease is prognostically more worrisome. Sorafenib, a multitargeted small molecule kinase inhibitor, including the VEGF receptor and BRAF kinase, has been evaluated in patients with thyroid cancer. The aim of the study was to present a case of metastatic thyroid cancer and the clinical course after the administration of sorafenib.
A patient, male, aged 54 years, had been operated upon for a multifocal papillary thyroid carcinoma in the left lobe of the gland 12 years ago. The patient had not received radioiodine treatment after surgery. During the preoperative evaluation for coronary bypass surgery lung lesions were discovered. On biopsy the lung lesions proved to be metastatic disease from the papillary thyroid carcinoma. Consequently, radioactive iodine 150 mCi was administered, followed by two other 150 mCi doses of radioactive iodine. Evaluation with a positron emission tomography scan with 18F-fluorodeoxyglucose revealed widespread metastatic disease in the lungs, the neck and a metastatic area in the liver. The patient was administered sorafenib 400 mg twice daily. Thyroglobulin levels decreased immediately from 226 ng/ml before to 45 ng/ml after treatment and the decrease was sustained. The patient developed transient diarrhea lasting a few days, tiredness and face paleness.
A case of a patient with metastatic thyroid cancer is presented who received sorafenib showing signs of a possible beneficial effect. The sustained decrease in thyroglobulin levels in this patient is a sign of a potential beneficial effect of sorafenib in metastatic thyroid carcinoma. However, an evaluation of objective tumor regression and larger trials are needed for the complete evaluation of the effect of sorafenib on the clinical course in patients with metastatic thyroid cancer.
25 - 29 Apr 2009
European Society of Endocrinology