Session: OR14-Thyroid Cancer: Insights into Diagnosis & Treatment
Room 103 (Moscone Center)
Methods: We performed a retrospective analysis of DTC patients who received salvage therapy with TKIs after first line sorafenib failure. Sorafenib failure was defined as PD or unacceptable toxicity leading to drug discontinuation. The objective was to compare the median time on treatment with sorafenib and second line TKIs and to assess the median OS.
Results: Twenty-one adult patients were identified (12 female, 9 male): 12 follicular, 8 papillary and 1 poorly differentiated carcinoma. Median age at diagnosis was 54 years (range 39-74). The majority had T3 and T4 tumors at diagnosis; median tumor size was 3.5 cm (range 1.8-9.5). Prior treatment included surgery (95%), radioactive iodine (100%), and radiation to the neck (33%). All patients had RAI refractory disease. Prior to sorafenib start, neck disease was present in 17/21 (81%) patients; most common sites of distant metastases included lung in all and bone in 9/21 (43%) patients. Median time from diagnosis to sorafenib start was 48 months (range 4-136). Sorafenib hold and dose reduction was needed in 13/21 (62%) and 10/21 (58%) patients, respectively. The reason for sorafenib discontinuation was PD in 19/21 (90%) and toxicity in 2/21 (10%) patients. Salvage therapy included sunitinib (8), pazopanib (2), vemurafenib (2) and investigational TKIs (9). Median time on treatment with sorafenib and salvage therapy was 46 and 61 weeks respectively (p=0.26). Estimated median OS was 166 weeks.
Conclusions: Duration of treatment is comparable between first and second line therapy suggesting an added clinical benefit of salvage TKI use after sorafeib failure. The median OS of our group of patients receiving multiple line TKIs after sorafenib failure is higher than previously reported on patients receiving first line sorafenib. This small retrospective study supports the potential utility of salvage TKI use after sorafenib failure, but further study, including a comparison against a control group and a prospective study, will be required.
Disclosure: MAH: Clinical Researcher, Eisai. NLB: Clinical Researcher, Bayer, Inc.. MC: Clinical Researcher, Exelixis, Inc., Clinical Researcher, Eisai, Clinical Researcher, Roche Diagnostics, Advisory Group Member, Exelixis, Inc., Advisory Group Member, Eisai. Nothing to Disclose: RD, MINH, SGW, AKY
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