Radio-iodine refractory thyroid cancer patients: a tailored follow-up based on clinicopathological features

Abstract

Objective: To report the experience of a single center for the selection of radioiodine-refractory (RAIR) thyroid cancer patients (RAIR-TC) who needed tyrosine kinase inhibitor (TKIs) treatment.

Patients and methods: We evaluated all features of 279 RAIR-TC patients both at the time of diagnosis and at the RAIR diagnosis.

Results: Ninety-nine patients received indication to TKIs (Group A), while 180 remained under active surveillance (Group B). Group A had greater tumor size, more aggressive histotype, more frequent macroscopic extrathyroidal extension, distant metastases, advanced AJCC stage, and higher ATA risk of recurrence. After RAIR diagnosis, 93.9% of Group A had progression of disease (PD) after which TKIs' therapy was started. The remaining 6.1% of patients had a so severe disease at the time of RAIR diagnosis that TKIs' therapy was immediately started. Among Group B, 42.7% had up to 5 PD, but the majority underwent local treatments. The mean time from RAIR diagnosis to the first PD was shorter in Group A, and the evidence of PD within 25 months from RAIR diagnosis was associated with the decision to start TKIs.

Conclusions: According to our results, a more tailored follow-up should be applied to RAIR-TC patients. A too strict monitoring and too many imaging evaluations might be avoided in those with less-aggressive features and low rate of progression. Conversely, RAIR-TC with an advanced stage at diagnosis and a first PD occurring within 25 months from RAIR diagnosis would require a more stringent follow-up to avoid a late start of TKIs.

Keywords: Metastatic differentiated thyroid cancer; Radioiodine-refractory thyroid cancer; Systemic therapy in thyroid cancer; Tyrosine kinase inhibitors.

Fig. 1

Cumulative probability of starting TKIs’ therapy considering the first progression of disease (PD) occurring within 25 months from the diagnosis of radioiodine refractoriness (cut-off time = 25 months was identified by ROC curve analysis; AUC: 0.713, p < 0.001)