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Case Report ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00712

Neoadjuvant multikinase inhibitor in patients with locally advanced unresectable thyroid carcinoma

 Carla Nava1, 2,  Rafael Scheffel1, 2,  Ana P. Cristo1, 2, Carla V. Ferreira1, 2, Shana Weber1, 2, Andre B. Zanella1, 2, Francisco C. Paixão2, 3, Alceu Migliavaca2, 3, Jose Ricardo Guimaraes3,  Marcia Graudrenz4,  Jose M. Dora1, 2 and  Ana Luiza Maia1, 2*
  • 1Clinical Hospital of Porto Alegre, Brazil
  • 2Federal University of Rio Grande do Sul, Brazil
  • 3Division of General Surgery, Clinical Hospital of Porto Alegre, Brazil
  • 4Division of Pathology, Clinical Hospital of Porto Alegre, Brazil

Background: Papillary thyroid carcinoma (PTC) is the most common and less aggressive thyroid cancer, but some patients may display locally advanced disease. Therapeutic options are limited in these cases, particularly for those patients with unresectable tumors. Neoadjuvant therapy is not part of the recommended work up.
Methods: Report a case of an unresectable grossly locally invasive PTC successfully managed with neoadjuvant therapy and provide a systematic review (SR) using the terms "Neoadjuvant therapy" AND "Thyroid carcinoma."
Results: A 32-year-old man with a 7.8 cm (in the largest dimension) PTC was referred to total thyroidectomy, but tumor resection was not feasible due to extensive local invasion (trachea, esophagus and adjacent structures). Sorafenib, a multikinase inhibitor (MKI), was initiated; a 70% tumor reduction was observed after 6 months, allowing new surgical intervention and complete resection. Radioactive iodine was administered as adjuvant therapy, and whole body scan (WBS) shows uptake on thyroid bed. One-year post-surgery the patient is asymptomatic with a status of disease defined as an incomplete biochemical response. The SR retrieved 123 studies on neoadjuvant therapy use in thyroid carcinoma; of them, 6 were extracted: 4 case reports and 2 observational studies. Multikinase inhibitors (MKI) were used as neoadjuvant therapy in three cases with 70-84% of tumor reduction allowing surgery.
Conclusion: Our findings, along with other reports, suggest that MKIs is an effective neoadjuvant therapy and should be considered as a therapeutic strategy for unresectable grossly locally invasive thyroid carcinomas.

Keywords: Multikinase inhibitor (MKI) therapy, Thyroid cancer, unresectable thyroid tumor, Neoadjuvant Therapy, Papillary thyroid cancer

Received: 17 Jun 2019; Accepted: 02 Oct 2019.

Copyright: © 2019 Nava, Scheffel, Cristo, Ferreira, Weber, Zanella, Paixão, Migliavaca, Guimaraes, Graudrenz, Dora and Maia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Ana Luiza Maia, Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil,