This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Santini, F. Articles by Pacini, F. Search for Related Content PubMed PubMed Citation Articles by Santini, F. Articles by Pacini, F. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CARBOPLATIN EPIRUBICIN LEVOTHYROXINE PLATINUM COMPOUNDS Medline Plus Health Information Thyroid Cancer

Cytotoxic Effects of Carboplatinum and Epirubicin in the Setting of an Elevated Serum Thyrotropin for Advanced Poorly Differentiated Thyroid Cancer

Departments of Endocrinology (F.S., V.B., R.E., L.M., A.P., F.P.), Radiology (S.M.), and Oncology (F.B.), University of Pisa, 56124 Pisa, Italy

Address all correspondence and requests for reprints to: Dr. Furio Pacini, Department of Endocrinology, University of Pisa, Via Paradisa 2, 56100 Pisa, Italy. E-mail: . fpacini{at}endoc.med.unipi.it

Abstract

Chemotherapy represents the only therapeutic option in most poorly differentiated thyroid carcinomas, although its effect is limited and short lasting. The aim of this study was to evaluate whether increasing the metabolic rate of thyroid cancer cells by TSH stimulation might result in higher response rate to chemotherapy. Fourteen patients with poorly differentiated thyroid carcinoma and nonfunctioning diffuse lung metastases detected at computed tomography scan, entered this study. A combination of carboplatinum and epirubicin was administered at 4- to 6-wk intervals for six courses. TSH stimulation was achieved by reduction of the daily dose of L-thyroxine resulting in mild hypothyroidism (eight patients) or by administration of recombinant human TSH (six patients). Two additional patients did not complete the therapeutic protocol due to severe hematological side effects. Results were evaluated by comparison of lung computed tomography scans before and after therapy. One patient had a complete remission. Five patients had partial remission, and seven patients had disease stabilization. One patient progressed to death. The overall rate of positive responses was 37% that rose to 81% when including patients with stable disease. Serum thyroglobulin after chemotherapy declined more than 50% in six patients, with respect to basal levels. Apparently, no difference in the response rate was observed between exogenous or endogenous TSH stimulation. At the time of this analysis, among the patients who completed the treatment courses, 9 of 14 patients (64.3%) are still alive (median survival from start of chemotherapy = 21 months, range: 15–34). Six of these patients did not show progression of lung disease, whereas regrowth of lung metastases was observed in three patients after 19, 20, and 21 months from chemotherapy, respectively. Five patients died of their disease, including the one who had progression of lung disease during chemotherapy, three who died for brain or bone metastases, and one who died for refractory local tumor invasion. No progression of lung metastases was observed until death in these four patients.

In conclusion, the response rate of poorly differentiated thyroid cancer to chemotherapy observed in this study was favorable and promising. TSH stimulation may have contributed to these results.

This article has been cited by other articles:

				M M Muresan, P Olivier, J Leclere, F Sirveaux, L Brunaud, M Klein, R Zarnegar, and G Weryha Bone metastases from differentiated thyroid carcinoma Endocr. Relat. Cancer, March 1, 2008; 15(1): 37 - 49. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W A Smit, W. Wiersinga, and the European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol., June 1, 2006; 154(6): 787 - 803. [Full Text] [PDF]

				R. Elisei, A. Vivaldi, R. Ciampi, P. Faviana, F. Basolo, F. Santini, C. Traino, F. Pacini, and A. Pinchera Treatment with Drugs Able to Reduce Iodine Efflux Significantly Increases the Intracellular Retention Time in Thyroid Cancer Cells Stably Transfected with Sodium Iodide Symporter Complementary Deoxyribonucleic Acid J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2389 - 2395. [Abstract] [Full Text] [PDF]

				E. Tirro, M. L. Consoli, M. Massimino, L. Manzella, F. Frasca, L. Sciacca, L. Vicari, G. Stassi, L. Messina, A. Messina, et al. Altered Expression of c-IAP1, Survivin, and Smac Contributes to Chemotherapy Resistance in Thyroid Cancer Cells. Cancer Res., April 15, 2006; 66(8): 4263 - 4272. [Abstract] [Full Text] [PDF]

				R. J. Robbins and A. K. Robbins Recombinant Human Thyrotropin and Thyroid Cancer Management J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 1933 - 1938. [Full Text] [PDF]