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Benefits and Limitations of TKIs in Patients with Medullary Thyroid Cancer: A Systematic Review and Meta-Analysis
dc.creator | Efstathiadou Z.A., Tsentidis C., Bargiota A., Daraki V., Kotsa K., Ntali G., Papanastasiou L., Tigas S., Toulis K., Pazaitou-Panayiotou K., Alevizaki M. | en |
dc.date.accessioned | 2023-01-31T07:37:06Z | |
dc.date.available | 2023-01-31T07:37:06Z | |
dc.date.issued | 2021 | |
dc.identifier | 10.1159/000509457 | |
dc.identifier.issn | 22350640 | |
dc.identifier.uri | http://hdl.handle.net/11615/71274 | |
dc.description.abstract | Introduction: Tyrosine kinase inhibitors (TKIs) have been used in patients with advanced medullary thyroid carcinoma (MTC); however, data on their effectiveness and safety are limited. The aim of this systematic review and meta-analysis was to document clinical response and toxicities of TKIs in advanced MTC. Methods: We systematically searched major databases for articles or abstracts on TKI use in MTC patients until May 2018. Objective response (OR), defined as the sum of complete + partial response, expressed as percentage, was our primary endpoint, while disease stability, disease progression (DP), median progression-free survival (PFS), and drug discontinuation rate due to adverse events (AEs) were secondary endpoints. Pooled percentages, PFS time, and 95% CIs were reported. Results: Thirty-three publications were finally included in the analysis: 1 phase IV, 2 phase III trials evaluating vandetanib and cabozantinib, respectively, 20 phase I or II studies, and the remaining 10 studies of retrospective-observational nature. OR was documented in 28.6% (95% CI 25.9-31.9) of patients. Stable disease was recorded in 46.2% (95% CI 43.3-49.1). Overall, DP was observed in 22.9% (95% CI 20.4-27.6). Grade 3 or more AEs occurred in 48.5% (95% CI 45.5-51.5) of patients, and drug discontinuation was reported in 44.7% (95% CI 41.7-47.6). In general, use of TKIs conferred a PFS of 23.3 months (95% CI 21.07-25.5). In particular, vandetanib induced an OR in 33.8% (95% CI 29.6-38.0) of patients and cabozantinib in 27.7% (95% CI 22.05-33.4). DP occurred in 23.7% (95% CI 19.9-27.6) with vandetanib use and in 22.6% (95% CI 17.4-27.9) in cabozantinib-treated patients. Sorafenib, the third most frequently studied drug, showed intermediate efficacy, but higher discontinuation rates. Conclusion: Treatment with TKIs in MTC patients with progressive disease is associated with a moderate therapeutic benefit, with achievement of either disease stability or partial response in 73%. The toxicity of these drugs is not negligible, but it is, nonetheless, manageable. © 2020 The Author(s) Published by S. Karger AG, Basel. | en |
dc.language.iso | en | en |
dc.source | European Thyroid Journal | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85091479298&doi=10.1159%2f000509457&partnerID=40&md5=8ca2b637a4adfafe38f319f8a4616de2 | |
dc.subject | afatinib | en |
dc.subject | aflibercept | en |
dc.subject | alectinib | en |
dc.subject | bevacizumab | en |
dc.subject | cabozantinib | en |
dc.subject | crizotinib | en |
dc.subject | cyclophosphamide | en |
dc.subject | doxorubicin | en |
dc.subject | gefitinib | en |
dc.subject | ibrutinib | en |
dc.subject | imatinib | en |
dc.subject | lapatinib | en |
dc.subject | larotrectinib | en |
dc.subject | nintedanib | en |
dc.subject | orantinib | en |
dc.subject | pazopanib | en |
dc.subject | protein tyrosine kinase inhibitor | en |
dc.subject | regorafenib | en |
dc.subject | sorafenib | en |
dc.subject | sunitinib | en |
dc.subject | tipifarnib | en |
dc.subject | vandetanib | en |
dc.subject | vatalanib | en |
dc.subject | abdominal pain | en |
dc.subject | adult | en |
dc.subject | advanced cancer | en |
dc.subject | adverse drug reaction | en |
dc.subject | anorexia | en |
dc.subject | arthralgia | en |
dc.subject | asthenia | en |
dc.subject | cancer patient | en |
dc.subject | cancer staging | en |
dc.subject | cancer survival | en |
dc.subject | clinical trial | en |
dc.subject | constipation | en |
dc.subject | controlled study | en |
dc.subject | dysphonia | en |
dc.subject | dyspnea | en |
dc.subject | fatigue | en |
dc.subject | headache | en |
dc.subject | heart ventricle arrhythmia | en |
dc.subject | human | en |
dc.subject | hypertension | en |
dc.subject | kidney disease | en |
dc.subject | meta analysis | en |
dc.subject | mucosa inflammation | en |
dc.subject | musculoskeletal pain | en |
dc.subject | myalgia | en |
dc.subject | Newcastle-Ottawa scale | en |
dc.subject | outcome assessment | en |
dc.subject | perception deafness | en |
dc.subject | peripheral edema | en |
dc.subject | pregnancy outcome | en |
dc.subject | progression free survival | en |
dc.subject | quality control | en |
dc.subject | retrospective study | en |
dc.subject | Review | en |
dc.subject | systematic review | en |
dc.subject | thyroid cancer | en |
dc.subject | thyroid medullary carcinoma | en |
dc.subject | toxicity | en |
dc.subject | treatment response time | en |
dc.subject | vomiting | en |
dc.subject | S. Karger AG | en |
dc.title | Benefits and Limitations of TKIs in Patients with Medullary Thyroid Cancer: A Systematic Review and Meta-Analysis | en |
dc.type | other | en |
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