Metastatic medullary cancer treated with Sorafenib: Service experience

Lidia Amalou; Amira Bouchenna; Abdelghani Tibouk; Brahim Ghennam; Bensalah Meriem

doi:10.1530/endoabs.110.EP1578

JOINT3123

Introduction: Medullary thyroid carcinoma (MTC) accounts for 3–8% of thyroid cancers. In 20% of cases, it is diagnosed at a metastatic stage. Tyrosine kinase inhibitors (TKIs) have revolutionized the management of advanced and metastatic MTC. Among them, Vandetanib and Cabozantinib are the two approved treatments. However, access to these therapies may be limited in certain settings, justifying the exploration of alternatives such as Sorafenib.

Methods: A retrospective analysis of four metastatic MTC patients treated with Sorafenib was conducted. Clinical data, treatment response, and adverse effects were assessed.

Discussion: MTC requires systemic therapy in metastatic cases. Sorafenib, a multikinase inhibitor targeting RET and VEGFR, is used off-label when standard therapies are unavailable. While it stabilizes disease in some cases, efficacy remains modest. Adverse effects may impact adherence, requiring careful monitoring. Further research is needed to define Sorafenib’s role and explore combination strategies.

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Caractéristiques	Patient 1	Patient 2	Patient 3	Patient 4
Age	64 years	72 years	70 years	32 years
Sex	Male	Male	Male	Male
History of MEN	No	No	No	No
Discovery mode	Cervical lymph-adenopathy.	Cervical lymph-adenopathy.	Cervical lymph-adenopathy	multiple pulmonary metastases.
Surgery	Total thyroidectomy with lymph node dissection.	Total thyroidectomy with central and bilateral jugulocarotid lymph node dissection.	Surgery declined due to multiple metastases.	Surgery declined due to multiple metastases.
Histopathology	PT3N1bM1	PT3aN1bM1	//	//
Metastatic sites	Pulmonary Tracheal	Pulmonary, lumbar	Mediastinal-hilar lymph node, pulmonary, bone, and liver	Pulmonary, cerebellar, bone, and mediastinal
Treatment	Radiotherapy then Sorafenib 800 mg/day, reduced to 600 mg/day	Doxorubicin and Cisplatin then Sorafenib 800 mg/day, reduced to 600 and 400 mg/day	Sorafenib 800 mg/day	Sorafenib 800 mg/day, then Vandetanib 300 mg/day, then Sorafenib 800 mg/day, reduced to 600 mg/day (stopped)
Outcome	Stability of secondary pulmonary lesions.	Stability of pulmonary lesions and 25% reduction of L4 lesion.	18% increase in thyroid mass, leading to a switch to Lenvatinib 24 mg/day.	Disease progression in the brain and bones, regression of pulmonary nodular lesions, and stable mediastinal lymph nodes.
Side effects	Diarrhea, weight loss, hand-foot syndrome	Diarrhea, hair loss.	Hypertension, hand-foot syndrome.	Hand-foot syndrome, vomiting, epigastric pain.

Conclusion: Sorafenib may be an alternative for metastatic MTC when standard treatments are unavailable. Close monitoring is essential to manage adverse effects and optimize outcomes.

Endocrine Abstracts

EP1578