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Thyroid 7893

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  • 1. THYROID CARCINOMA TREATMENT REGIMENS The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Drug dose modifications and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and because of individual patient variability, prior treatment, and comorbidities. Thus, the optimal delivery of anticancer agents requires a healthcare delivery team experienced in the use of such agents and the management of associated toxicities in patients with cancer. The cancer treatment regimens below may include both FDA-approved and unapproved uses/regimens and are provided as references only to the latest treatment strategies. Clinicians must choose and verify treatment options based on the individual patient. NOTE: GREY SHADED BOXES CONTAIN UPDATED REGIMENS. General treatment note: Chemotherapy is NOT indicated for papillary, follicular, or Hürthle thyroid carcinoma.1 First-Line Combination Therapy Papillary Carcinoma1 Total thyroidectomy. Post-surgical therapy may include radioiodine treatment or adjuvant radioiodine ablation. For bone metastases, bisphosphonate or denosumab therapy may be considered. Follicular Carcinoma1 Total thyroidectomy if invasive cancer, metastatic cancer, or patient preference. Post-surgical therapy may include radioiodine treatment or adjuvant radioiodine ablation. For bone metastases, bisphosphonate or denosumab therapy may be considered. Hürthle Carcinoma1 Total thyroidectomy if invasive cancer or patient preference. Post-surgical therapy may include radioiodine treatment or adjuvant radioiodine ablation. For bone metastases, bisphosphonate or denosumab therapy may be considered. For clinically progressive or symptomatic disease, consider studies for non-radioiodine-sensitive tumors, small molecular kinase inhibitor (sorafenib [Nexavar] or sunitinib [Sutent]), or systemic therapy. Medullary Carcinoma1 Total thyroidectomy. Vandetanib (Caprelsa) 300mg orally once daily until disease progression or toxicity occurs (used for unresectable locoregional or metastatic disease that is symptomatic or progressive).2 Symptomatic distant metastases: Clinical trial is preferred.» Small molecular kinase inhibitor (sorafenib [Nexavar] or sunitinib [Sutent]).» 3,4 Dacarbazine (DTIC)-based chemotherapy.» 5 For bone metastases, bisphosphonate or denosumab therapy may be considered.» Anaplastic Carcinoma1 Locally resectable or unresectable local tumor—clinical trial preferred. Consider external beam radiotherapy and/or chemotherapy. References 1. NCCN Clinical Practice Guidelines in Oncology™.Thyroid Carci- noma. v 2.2012. Available at: http://www.nccn.org/profession als/physician_gls/pdf/thyroid.pdf. Accessed March 23, 2012. 2. Caprelsa [package insert].Wilmington, DE: AstraZeneca Pharmaceuticals, LP. 2011. 3. Ravaud A, de la Fouchardière C,Asselineau J, et al. Efficacy of sunitinib in advanced medullary thyroid carcinoma: intermediate results of phase II THYSU. Oncologist. 2010;15(2):212–213. 4. Sherman SI.Advances in chemotherapy of differentiated epithelial and medullary thyroid cancers. J Clin Endocrinol Metab. 2009;94(5):1493–1499. 5. Nocera M, Baudin E, Pellegriti G, Cailleux AF, Mechelany- Corone C, Schlumberger M.Treatment of advanced medullary thyroid cancer with an alternating combination of doxorubicin- streptozocin and 5 FU-dacarbazine. Groupe d’Etude des Tumeurs à Calcitonine (GETC). Br J Cancer.2000;83(6):715–718. (Revised 03/2012) © 2012 Haymarket Media, Inc.