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Sorafenib and radioiodine-refractory differentiated thyroid cancer (RR-DTC): a systematic review and meta-analysis

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Abstract

Background

Except conventional treatments, research on medical approach for radioiodine-refractory differentiated thyroid cancer (RR-DTC) was considered particularly challenging. Sorafenib, a novel biological agent, has been widely studied in the treatment of RR-DTC for years. We performed a systematic review and meta-analysis to explore the efficiency and safety of treating RR-DTC patients with sorafenib.

Methods

An electronic search on PubMed/Medline and Embase was carried out to search associated articles. Fixed-effects or random-effects models were chose according to the heterogeneity.

Results

A total of 15 eligible studies (636 patients) were included. As shown by the only randomised clinical trial-DECISION, sorafenib significantly improved progression-free survival (PFS) compared with placebo in patients with progressive RR-DTC. The pooled analysis indicated that there were 26% patients (95% CI: 0.19–0.34) achieved partial response (PR), and 44% patients (98% CI: 0.39–0.48) achieved stable disease (SD). The most frequent adverse effects (AEs) observed included hand-foot syndrome (HFS), diarrhoea, fatigue, alopecia, weight loss (WS) and rash, the incidence of all grades AEs for which were 71%, 60%, 59%, 55%, 51% and 50%, respectively. There were 68% patients (252/368), who had a dose reduction because of the drug toxicities and AEs.

Conclusions

Sorafenib could improve PFS in patients with progressive RR-DTC, comparing with placebo. Due to the resistance to conventional treatments, sorafenib is considered as a promising treatment for RR-DTC by most physicians specialised in this field. However, the use of sorafenib should be cautious due to a high incidence of AEs caused by the agent. More effective agents with less toxicities are warranted.

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Author information

Authors and Affiliations

  1. Department of Thyroid & Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, China

    Guoli Feng & Jingqiang Zhu

  2. Department of Thyroid & Breast Surgery, Affiliated Hospital Of Zunyi Medical University, Zunyi, China

    Yi Luo & Qi Zhang

  3. Department of Thyroid & Breast Surgery, The Second Affiliated Hospital Of Zunyi Medical University, Zunyi, China

    Feng Zeng

  4. School of Public Health, Zunyi Medical University, Zunyi, China

    Jie Xu

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  1. Guoli Feng
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  2. Yi Luo
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  3. Qi Zhang
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  4. Feng Zeng
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  5. Jie Xu
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Contributions

J.Z. designed the research. G.F. searched and independently assessed the eligibility of all potential publications. G.F. and Q.Z. conducted data extraction according to the PRISMA statement. J.X. carried out the statistical analyses. G.F. wrote the manuscript, supervised by J.Z. All authors contributed to the revising the article, and agree to be accountable for all aspects of the work.

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Correspondence to Jingqiang Zhu.

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The authors declare that they have no conflict of interest.

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All the studies included in the meta-analysis were conducted in accordance with the ethical standards of the institutional and/or national research committee, and obtained written informed consent from all participants.

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Feng, G., Luo, Y., Zhang, Q. et al. Sorafenib and radioiodine-refractory differentiated thyroid cancer (RR-DTC): a systematic review and meta-analysis. Endocrine 68, 56–63 (2020). https://doi.org/10.1007/s12020-019-02167-6

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