Targeted Therapy in Refractory Thyroid Cancer

Current Achievements and Limitations

Lucia Brilli; Furio Pacini

Disclosures

Future Oncol. 2011;7(5):657-668. 

In This Article

Side Effects & Toxicities

Tyrosine kinase inhibitors are generally fairly well tolerated and have lower toxicity than chemotherapy.[104] Adverse events are evaluated, by convention, considering the National Cancer Institute's Common Terminology Criteria for Adverse Events, in which severity of each event can be classified by various grades and, accordingly to these, drug study is temporarily or permanently withdrawn, or the dosage is reduced.

The most common adverse events are represented by constitutional symptoms, such as fatigue, weight loss, diarrhea and nausea; although they only rarely reach grade 3 or 4 severity, for which temporary discontinuation or dosage reduction is required (Table 3).

Hypertension is a common side effect with all VEGF inhibitors; total incidence varies from 17 to 56%, with grade ≥3 varying between 2 and 25%. Recently, a consensus regarding the initial assessment and consequent management of patients developing hypertension while receiving VEGF pathway inhibitors has been reported.[43]

Common to almost all TKIs is the occurrence of a series of cutaneous adverse events including hand–foot skin reaction, mucositis, papulopustolar rash, alopecia and xerosis.[101] Usually, these events occur within 6 weeks of therapy and often in the first 2 weeks. So far, no consensus exists regarding the treatment algorithm to follow in these cases, but expert recommendations and proposed algorithms have been delivered.[44]

Another common side effect with some TKIs is the increase of serum thyroid stimulating hormone, which often requires an adjustment of L-tyroxine therapy.[45] The intimate mechanism of this alteration is still unknown but an interference in thyroid hormone metabolism or a decrease in L-tyroxine absorption have been postulated.

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