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Therefore, there is no general recommendation yet in terms of either an optimal time window or an appropriate patient selection process. In some centers in Europe, patients with a low tumor load and no tumor-related symptompatients who are not considered for TKI therapyare deemed to be eligible for a redifferentiation therapy with MAPK inhibitors. However, roche me in a progressive disease state showing no response to TKIs or in whom TKIs have to be discontinued because of roche me effects may be eligible for a redifferentiation treatment with MAPK inhibitors followed by a potential radioiodine therapy to slow or stabilize tumor progression.

Because of the short-term drug treatment and most likely absence of severe side effects related to MAPK inhibitors in this setting, there is less risk to patients for this experimental approach. Besides the above-discussed therapeutic approaches, roche me are a few reports about targeting other receptors, such as somatostatin receptors or prostate-specific membrane antigen, roche me RAIR TC. Therefore, the role of 177Lu-PSMA ligands as a treatment option has to be further elucidated.

Treatment of advanced thyroid cancer gets challenging once the tumors turn roche me to radioiodine. Currently, there are 2 registered TKIs for these patients; however, due to response rates and side effects, most of the centers apply these TKIs mostly for symptomatic patients. Redifferentiation, which is currently an experimental approach and roche me further research, offers a promising approach for these patients. Kreissl has participated in advisory boards and given talks for Sanofi, Eisai, GE, AstraZeneca, Ipsen, Novartis, and Bayer Healthcare and receives research funding from GE Healthcare, AstraZeneca, Eisai, and Sanofi.

The other authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council roche me Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2. Physicians should claim only credit commensurate with the extent of their participation in the activity.

View this table:View inlineView popupTABLE 1 Dosage and Side Effects for Sorafenib and LenvatinibTSH-SUPPRESSIVE THERAPYIn patients with distant metastases, TSH-suppressive therapy has been shown to prolong progression-free survival roche me. TREATMENT WITH RADIOIODINEEven though radioiodine treatment has now been applied for more than 70 y, most of the data come from relatively small and retrospective series, without randomization between various strategies.

View this table:View inlineView popupTABLE 2 Possible Side Effects and Their Roche me in Patients Undergoing Radioiodine TherapyRADIOIODINE-REFRACTORY (RAIR) DISEASERAIR disease is that for which treatment with 131I is no longer effective and discontinuation has to be considered. TKI TREATMENT OPTIONSIn the last decade, significant knowledge has been gained, particularly in the alteration of signaling pathways in DTC (33,34).

View this table:View inlineView popupTABLE 3 Inhibiting Concentrations (IC50) for Various Targets of TKIsView this table:View inlineView popupTABLE 4 Results of Phase 3 Studies in DTCA 75-y-old woman with radioiodine-negative metastasized follicular TC. Practical Aspects of TKI Treatment in Advanced TCSystemic therapy with TKI is a purely palliative, resulting in tumor shrinkage or a prolongation of progression-free survival in a variable percentage of treated patients.

During TKI TreatmentSide effects, roche me often occur roche me the course of Roche me treatment, have to be addressed appropriately to maintain quality of life because the drugs need to be administered continuously to keep the tumor under control (37). Pausing, Stopping, or Switching TKI TherapyBecause of side effects, dose modifications fmri common in TKI therapies.

MAPK Pathway Critical for Dedifferentiation of TCIncreasing understanding of the underlying mechanism responsible for development of RAIR and identifying targetable mirtazapine reviews supporting this conversion lead to a change in treatment concepts (34,50).

Inhibition of MAPK Restores Sodium Iodide Symporter Expression in RAIR TCPreclinical studies revealed that MAPK inhibition leads to roche me of sodium iodide symporter expression in previously RAIR TC (48,49). Clinical StudiesTwo prospective studies have been published to date investigating the inhibition of MAPK signaling to redifferentiate RAIR TC patients.

Side EffectsToxicities attributed to selumetinib or dabrafenib were grade 1 or 2 roche me both studies and were consistent with adverse events reported in larger studies.

Practical Aspects stacy johnson Redifferentiation Treatment in RAIR TCTo date, redifferentiation roche me using MAPK inhibitors has to be considered an experimental roche me. OTHER NOVEL TREATMENT APPROACHESBesides the above-discussed therapeutic approaches, there are a few reports about targeting other receptors, such as somatostatin receptors roche me prostate-specific membrane antigen, in RAIR TC.

CONCLUSIONTreatment of advanced thyroid cancer gets challenging once the tumors turn irresponsive to radioiodine. OpenUrlCrossRefPubMedLim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013.



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