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Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective

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Abstract

Radioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.

Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world’s population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.

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Abbreviations

AE:

Adverse events

ATA:

American Thyroid Association

CR:

Complete response

CT:

Computed tomography

DTC:

Differentiated thyroid cancer

ECOG:

Eastern Cooperative Oncologic Group

EMA:

European Medicines Agency

FDA:

Food and Drug Administration

FDG-PET/CT:

18 F-fluorodeoxyglucose positron-emission tomography-computed tomography

FTC:

Follicular thyroid cancer

LA:

Latin America

LATS:

Latin American Thyroid Society

MAPK:

Mitogen-activated protein kinase

MKI:

Multikinase inhibitors

MRI:

Magnetic resonance imaging

NGS:

Next-generation sequencing

NIS:

Na/I symporter

NTRK:

Neurotrophic tyrosine receptor kinase

ORR:

Overall response rate

OS:

Overall survival

PFS:

Progression-free survival

PI3K:

Phosphatidylinositol-3 kinase

PR:

Partial response

PTC:

Papillary thyroid cancer

RAI:

Radioiodine

RAI-R:

Radioiodine-refractory

RECIST:

Response Evaluation Criteria In Solid Tumors

RET:

Rearranged during transfection

RTK:

Tyrosine kinase receptors

SD:

Stable disease

sTKI:

Selective tyrosine kinase inhibitor

Tg:

Thyroglobulin

TRKs:

Tropomyosin receptor kinase

VEGFR:

Vascular endothelial growth factor receptor

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Authors and Affiliations

  1. Hospital de Clínicas José de San Martín – University of Buenos Aires, Buenos Aires, Argentina

    Fabian Pitoia

  2. Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Rafael Selbach Scheffel & Ana Luiza Maia

  3. Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Rafael Selbach Scheffel

  4. Endocrinology Division, Instituto de Oncología AH Roffo, University of Buenos Aires, Buenos Aires, Argentina

    Ines Califano

  5. Endocrinology Division, Hospital Ramos Mejía, Gobierno Ciudad de Buenos Aires, Argentina

    Alicia Gauna

  6. Centro de tiroides, Facultad de Medicina Clínica Alemana, Clínica Alemana de Santiago, Universidad del desarrollo, Santiago, Chile

    Hernán Tala

  7. Onco endocrinology Service, Endocrinology Service, Faculdade de Medicina, Instituto Nacional do Cancer (INCa), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Fernanda Vaisman

  8. Deparment of Internal Medicine, Endocrine Section, Universidad de Antioquia. Hospital Universitario San Vicente Fundación. Medellin, Medellín, Colombia

    Alejandro Roman Gonzalez

  9. Endocrine Oncology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil

    Ana Oliveira Hoff

  10. Thyroid Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350 - CEP 90035–003, Brazil

    Ana Luiza Maia

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  1. Fabian Pitoia
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  2. Rafael Selbach Scheffel
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Contributions

All authors contributed to the study conception and design. Literature search and data analysis was made by all authors. The first draft of the manuscript was written by Fabian Pitoia and all authors commented on previous versions of the manuscript. Rafael Selbach Scheffel and Ana Luisa Maia critically revised the work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ana Luiza Maia.

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Conflict of interest

- Ana Luiza Maia: principal investigator in multicenter studies for Sanofi-Genzyme, Exelixis and Lilly.

- Fabian Pitoia: principal investigator in multicenter studies for Bayer, Exelixis and Novartis. Speaker for Bayer.

- Rafael Selbach Scheffel: subinvestigator in multicenter studies for Sanofi-Genzyme, Exelixis and Lilly.

- Ines Califano: subinvestigaton in multicenter studies for Novartis. Speaker for Bayer, Biotoscana/Knigtt, Raffo and Roche.

- Alicia Gauna: no conflicts of interest.

- Hernán Tala: no conflicts of interest.

- Fernanda Vaisman: principal investigator in multicenter studies for AstraZenca, Bayer, Lilly, Exelixis and Roche. Speaker for Abbott Laboratórios, Sanofi-Genzyme, Merck, Knight, Lilly, Ipsen, Onkos and Bayer. Advisory Board for Sanofi-Genzyme, Knight, Ipsen, Merck, Lilly and Bayer.

- Alejandro Roman Gonzalez: principal investigator in multicenter studies for Novartis, Sanofi and Amgen. Speaker for Biotoscana, Ultragenyx, Bayer, Ipsen, Amgen, Valentech and Recordati. Research fees for research from Corcept.

- Ana Oliveira Hoff: research support from Exelixis, Lilly and Novartis. Consulting (advisory board) for Exelixis, Knight, Eli Lilly and Bayer. Consulting (steering committee) for Eli Lilly. Speaker for Bayer.

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Pitoia, F., Scheffel, R.S., Califano, I. et al. Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective. Rev Endocr Metab Disord 25, 109–121 (2024). https://doi.org/10.1007/s11154-023-09818-0

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  • DOI: https://doi.org/10.1007/s11154-023-09818-0

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