Application value of multidisciplinary team in diagnosis and treatment of advance special thyroid cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUAN Xiaoqing ¹ ,  ZHENG Xiangxin ¹ , GU Shucheng ¹ , YUAN Mu ¹ , WU Ji ¹ , JIANG Xiaoling ² , SHI Xiaohong ² , NIU Lei ³ , ZHENG Zhongfeng ⁴ , LU Xiyan ⁵

1. Department of Thyroid & Breast Surgery, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, P. R. China;
2. Department of Pathology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, P. R. China;
3. Department of Imaging Division, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, P. R. China;
4. Department of Thoracic Surgery, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, P. R. China;
5. Department of Oncology, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, P. R. China;

Corresponding author：

ZHENG Xiangxin, Email: zhengxiangxin_dr@163.com

Keywords：

thyroid cancer; advance; special type; apatinib; low dose; single drug

DOI：

10.7507/1007-9424.201806027

Video：

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Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.

Citation： GUAN Xiaoqing, ZHENG Xiangxin, GU Shucheng, YUAN Mu, WU Ji, JIANG Xiaoling, SHI Xiaohong, NIU Lei, ZHENG Zhongfeng, LU Xiyan. Application value of multidisciplinary team in diagnosis and treatment of advance special thyroid cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(9): 1115-1120. doi: 10.7507/1007-9424.201806027 Copy

1.	中国临床肿瘤学会抗肿瘤药物安全管理专家委员会. 阿帕替尼治疗胃癌的临床应用专家共识. 临床肿瘤学杂志, 2015, 20(9): 841-847.
2.	丁林, 江志敏, 李怀. 晚期非小细胞肺癌抗血管生成治疗: 文献复习及病例报道. 岭南现代临床外科, 2015, 15(6): 656-660.
3.	Fontanella C, Ongaro E, Bolzonello S, et al. Clinical advances in the development of novel VEGFR2 inhibitors. Ann Transl Med, 2014, 2(12): 123.
4.	涂艳, 彭枫. 阿帕替尼治疗恶性肿瘤的临床研究进展. 中国肿瘤临床, 2016, 43(12): 545-548.
5.	林岩松, 王宸, 李慧, 等. 甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效的安全性初步报告. 中国癌症杂志, 2016, 26(9): 721-726.
6.	丛慧, 梁军, 林岩松. 碘难治性分化型甲状腺癌的诊断与靶向治疗. 国际放射医学核医学杂志, 2015, 39(1): 25-31.
7.	张鑫, 王宸, 梁军, 等. 进展性碘难治性分化型甲状腺癌患者阿帕替尼治疗后血清学与影像学指标变化. 中国肿瘤临床, 2017, 44(8): 371-376.
8.	林岩松, 杨雪. RAIR-DTC的诊治进展. 中国癌症杂志, 2017, 27(6): 442-450.
9.	鄢丹桂, 张彬, 李正江, 等. 甲状腺髓样癌颈部淋巴转移规律的临床研究. 中华耳鼻咽喉头颈外科杂志, 2015, 50(4): 290-294.
10.	Moley JF. Medullary thyroid carcinoma: management of lymph node metastases. J Natl Compr Canc Netw, 2010, 8(5): 549-556.
11.	高云飞, 邓维叶, 陈艳峰, 等. 甲状腺髓样癌预后相关因素分析(附 118 例报告). 中国实用外科杂志, 2015, 35(9): 996-1000.
12.	董薇, 陈晓红. 甲状腺髓样癌研究进展. 国际耳鼻咽喉头颈外科杂志, 2013, 37(1): 42-46.
13.	蒋尧瀛, 姜成威, 王喆辉, 等. 甲状腺未分化癌 5 例临床病理特征分析. 临床与实验病理学杂志, 2016, 32(11): 1281-1283.
14.	孙滨, 郭伯敏, 康杰, 等. 甲状腺未分化癌的规范化治疗. 山东大学耳鼻喉眼学报, 2017, 31(6): 16-20.
15.	Anderson RT, Linnehan JE, Tongbram V, et al. Clinical, safety, and economic evidence in radioactive iodine-refractory differentiated thyroid cancer: a systematic literature review. Thyroid, 2013, 23(4): 392-407.
16.	代文杰, 朱化强. 甲状腺癌的分子靶向治疗. 中国实用外科杂志, 2011, 31(5): 456-458.
17.	Schlumberger M, Brose M, Elisei R, et al. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol, 2014, 2(5): 356-358.
18.	Gild ML, Bullock M, Robinson BG, et al. Multikinase inhibitors: a new option for the treatment of thyroid cancer. Nat Rev Endocrinol, 2011, 7(10): 617-624.
19.	刘泽明, 李大鹏, 黄韬. 甲状腺癌分子靶向治疗的现状和前景展望. 中国现代普通外科进展, 2013, 16(1): 43-46.
20.	Perez CA, Santos ES, Arango BA, et al. Novel molecular targeted therapies for refractory thyroid cancer. Head Neck, 2012, 34(5): 736-745.
21.	高明. 国内分化型甲状腺癌诊疗方向和对策. 中国实用外科杂志, 2011, 31(5): 376-379.
22.	王波, 赵文新. 甲状腺癌靶向治疗进展. 中国实用外科杂志, 2015, 35(6): 674-678.
23.	安常明, 王铮, 韩志楷, 等. 索拉非尼联合脂质体阿霉素治疗甲状腺低分化癌裸鼠移植瘤的疗效观察. 中华耳鼻咽喉头颈外科杂志, 2012, 47(11): 931-936.
24.	Gule MK, Chen Y, Sano D, et al. Targeted therapy of VEGFR2 and EGFR significantly inhibits growth of anaplastic thyroid cancer in an orthotopic murine model. Clin Cancer Res, 2011, 17(8): 2281-2291.
25.	Grosse J, Warnke E, Wehland M, et al. Mechanisms of apoptosis in irradiated and sunitinib-treated follicular thyroid cancer cells. Apoptosis, 2014, 19(3): 480-490.
26.	Di Desidero T, Fioravanti A, Orlandi P, et al. Antiproliferative and proapoptotic activity of sunitinib on endothelial and anaplastic thyroid cancer cells via inhibition of Akt and ERK1/2 phosphorylation and by down-regulation of cyclin-D1. J Clin Endocrinol Metab, 2013, 98(9): E1465-E1473.
27.	Fenton MS, Marion KM, Salem AK, et al. Sunitinib inhibits MEK/ERK and SAPK/JNK pathways and increases sodium/iodide symporter expression in papillary thyroid cancer. Thyroid, 2010, 20(9): 965-974.
28.	Mologni L, Redaelli S, Morandi A, et al. Ponatinib is a potent inhibitor of wild-type and drug-resistant gatekeeper mutant RET kinase. Mol Cell Endocrinol, 2013, 377(1-2): 1-6.
29.	龚艳萍, 刘枫, 邹秀和, 等. 甲状腺髓样癌的诊治进展. 中国普外基础与临床杂志, 2016, 23(5): 620-625.
30.	Cohen EE, Tortorici M, Kim S, et al. A phase Ⅱ trial of axitinib in patients with various histologic subtypes of advanced thyroid cancer: long-term outcomes and pharmacokinetic/pharmacodynamic analyses. Cancer Chemother Pharmacol, 2014, 74(6): 1261-1270.
31.	Díez JJ, Iglesias P, Alonso T, et al. Activity and safety of sunitinib inpatients with advanced radioactive iodine-refractory differentiated thyroid carcinoma in clinical practice. Endocrine, 2015, 48(2): 582-588.
32.	Bible KC, Suman VJ, Molina JR, et al. Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study. Lancet Oncol, 2010, 11(10): 962-972.
33.	Longo R, Gasparini G. Challenges for patient selection with VEGF inhibitors. Cancer Chemother Pharmacol, 2007, 60(2): 151-170.
34.	徐德全, 代文杰. 甲状腺髓样癌的靶向治疗. 中国普外基础与临床杂志, 2014, 21(12): 1579-1582.
35.	曹邦伟, 赵鹏飞. 阿帕替尼治疗胃癌及其他肿瘤的研究现状. 临床与病理杂志, 2016, 36(6): 815-823.
36.	Li J, Qin S, Xu J, et al. A randomized, double-blind, multicenter, phase Ⅱ, three-arm, placebo-control study of apatinib as third-line treatment in patients with metastatic gastric carcinoma. J Clin Oncol, 2011, 29(Suppl): Abstr4019.
37.	Li J, Qin S, Xu J, et al. Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: results from a randomized, placebo-controlled, parallel-arm, phase Ⅱ trial. J Clin Oncol, 2013, 31(26): 3219-3225.
38.	Qin S. Phase Ⅲ study of apatinib in advanced gastric cancer: A randomized, double-blind, placebo-controlled trial. J Clin Oncol, 2014, 32(Suppl): Abst4003.

1. 中国临床肿瘤学会抗肿瘤药物安全管理专家委员会. 阿帕替尼治疗胃癌的临床应用专家共识. 临床肿瘤学杂志, 2015, 20(9): 841-847.
2. 丁林, 江志敏, 李怀. 晚期非小细胞肺癌抗血管生成治疗: 文献复习及病例报道. 岭南现代临床外科, 2015, 15(6): 656-660.
3. Fontanella C, Ongaro E, Bolzonello S, et al. Clinical advances in the development of novel VEGFR2 inhibitors. Ann Transl Med, 2014, 2(12): 123.
4. 涂艳, 彭枫. 阿帕替尼治疗恶性肿瘤的临床研究进展. 中国肿瘤临床, 2016, 43(12): 545-548.
5. 林岩松, 王宸, 李慧, 等. 甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效的安全性初步报告. 中国癌症杂志, 2016, 26(9): 721-726.
6. 丛慧, 梁军, 林岩松. 碘难治性分化型甲状腺癌的诊断与靶向治疗. 国际放射医学核医学杂志, 2015, 39(1): 25-31.
7. 张鑫, 王宸, 梁军, 等. 进展性碘难治性分化型甲状腺癌患者阿帕替尼治疗后血清学与影像学指标变化. 中国肿瘤临床, 2017, 44(8): 371-376.
8. 林岩松, 杨雪. RAIR-DTC的诊治进展. 中国癌症杂志, 2017, 27(6): 442-450.
9. 鄢丹桂, 张彬, 李正江, 等. 甲状腺髓样癌颈部淋巴转移规律的临床研究. 中华耳鼻咽喉头颈外科杂志, 2015, 50(4): 290-294.
10. Moley JF. Medullary thyroid carcinoma: management of lymph node metastases. J Natl Compr Canc Netw, 2010, 8(5): 549-556.
11. 高云飞, 邓维叶, 陈艳峰, 等. 甲状腺髓样癌预后相关因素分析(附 118 例报告). 中国实用外科杂志, 2015, 35(9): 996-1000.
12. 董薇, 陈晓红. 甲状腺髓样癌研究进展. 国际耳鼻咽喉头颈外科杂志, 2013, 37(1): 42-46.
13. 蒋尧瀛, 姜成威, 王喆辉, 等. 甲状腺未分化癌 5 例临床病理特征分析. 临床与实验病理学杂志, 2016, 32(11): 1281-1283.
14. 孙滨, 郭伯敏, 康杰, 等. 甲状腺未分化癌的规范化治疗. 山东大学耳鼻喉眼学报, 2017, 31(6): 16-20.
15. Anderson RT, Linnehan JE, Tongbram V, et al. Clinical, safety, and economic evidence in radioactive iodine-refractory differentiated thyroid cancer: a systematic literature review. Thyroid, 2013, 23(4): 392-407.
16. 代文杰, 朱化强. 甲状腺癌的分子靶向治疗. 中国实用外科杂志, 2011, 31(5): 456-458.
17. Schlumberger M, Brose M, Elisei R, et al. Definition and management of radioactive iodine-refractory differentiated thyroid cancer. Lancet Diabetes Endocrinol, 2014, 2(5): 356-358.
18. Gild ML, Bullock M, Robinson BG, et al. Multikinase inhibitors: a new option for the treatment of thyroid cancer. Nat Rev Endocrinol, 2011, 7(10): 617-624.
19. 刘泽明, 李大鹏, 黄韬. 甲状腺癌分子靶向治疗的现状和前景展望. 中国现代普通外科进展, 2013, 16(1): 43-46.
20. Perez CA, Santos ES, Arango BA, et al. Novel molecular targeted therapies for refractory thyroid cancer. Head Neck, 2012, 34(5): 736-745.
21. 高明. 国内分化型甲状腺癌诊疗方向和对策. 中国实用外科杂志, 2011, 31(5): 376-379.
22. 王波, 赵文新. 甲状腺癌靶向治疗进展. 中国实用外科杂志, 2015, 35(6): 674-678.
23. 安常明, 王铮, 韩志楷, 等. 索拉非尼联合脂质体阿霉素治疗甲状腺低分化癌裸鼠移植瘤的疗效观察. 中华耳鼻咽喉头颈外科杂志, 2012, 47(11): 931-936.
24. Gule MK, Chen Y, Sano D, et al. Targeted therapy of VEGFR2 and EGFR significantly inhibits growth of anaplastic thyroid cancer in an orthotopic murine model. Clin Cancer Res, 2011, 17(8): 2281-2291.
25. Grosse J, Warnke E, Wehland M, et al. Mechanisms of apoptosis in irradiated and sunitinib-treated follicular thyroid cancer cells. Apoptosis, 2014, 19(3): 480-490.
26. Di Desidero T, Fioravanti A, Orlandi P, et al. Antiproliferative and proapoptotic activity of sunitinib on endothelial and anaplastic thyroid cancer cells via inhibition of Akt and ERK1/2 phosphorylation and by down-regulation of cyclin-D1. J Clin Endocrinol Metab, 2013, 98(9): E1465-E1473.
27. Fenton MS, Marion KM, Salem AK, et al. Sunitinib inhibits MEK/ERK and SAPK/JNK pathways and increases sodium/iodide symporter expression in papillary thyroid cancer. Thyroid, 2010, 20(9): 965-974.
28. Mologni L, Redaelli S, Morandi A, et al. Ponatinib is a potent inhibitor of wild-type and drug-resistant gatekeeper mutant RET kinase. Mol Cell Endocrinol, 2013, 377(1-2): 1-6.
29. 龚艳萍, 刘枫, 邹秀和, 等. 甲状腺髓样癌的诊治进展. 中国普外基础与临床杂志, 2016, 23(5): 620-625.
30. Cohen EE, Tortorici M, Kim S, et al. A phase Ⅱ trial of axitinib in patients with various histologic subtypes of advanced thyroid cancer: long-term outcomes and pharmacokinetic/pharmacodynamic analyses. Cancer Chemother Pharmacol, 2014, 74(6): 1261-1270.
31. Díez JJ, Iglesias P, Alonso T, et al. Activity and safety of sunitinib inpatients with advanced radioactive iodine-refractory differentiated thyroid carcinoma in clinical practice. Endocrine, 2015, 48(2): 582-588.
32. Bible KC, Suman VJ, Molina JR, et al. Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study. Lancet Oncol, 2010, 11(10): 962-972.
33. Longo R, Gasparini G. Challenges for patient selection with VEGF inhibitors. Cancer Chemother Pharmacol, 2007, 60(2): 151-170.
34. 徐德全, 代文杰. 甲状腺髓样癌的靶向治疗. 中国普外基础与临床杂志, 2014, 21(12): 1579-1582.
35. 曹邦伟, 赵鹏飞. 阿帕替尼治疗胃癌及其他肿瘤的研究现状. 临床与病理杂志, 2016, 36(6): 815-823.
36. Li J, Qin S, Xu J, et al. A randomized, double-blind, multicenter, phase Ⅱ, three-arm, placebo-control study of apatinib as third-line treatment in patients with metastatic gastric carcinoma. J Clin Oncol, 2011, 29(Suppl): Abstr4019.
37. Li J, Qin S, Xu J, et al. Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: results from a randomized, placebo-controlled, parallel-arm, phase Ⅱ trial. J Clin Oncol, 2013, 31(26): 3219-3225.
38. Qin S. Phase Ⅲ study of apatinib in advanced gastric cancer: A randomized, double-blind, placebo-controlled trial. J Clin Oncol, 2014, 32(Suppl): Abst4003.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application value of multidisciplinary team in diagnosis and treatment of advance special thyroid cancer

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