PMID- 29704768
OWN - NLM
STAT- MEDLINE
DCOM- 20180604
LR  - 20180604
IS  - 1532-1967 (Electronic)
IS  - 0305-7372 (Linking)
VI  - 66
DP  - 2018 May
TI  - Management of treatment-related toxicities in advanced medullary thyroid cancer.
PG  - 64-73
LID - S0305-7372(18)30051-3 [pii]
LID - 10.1016/j.ctrv.2018.04.007 [doi]
AB  - Progress in the treatment of advanced medullary thyroid cancer (MTC) has resulted 
      from the approval of 2 drugs within the past 5 years, vandetanib and 
      cabozantinib. These multikinase inhibitors (MKIs) possess overlapping 
      specificities for multiple kinase targets implicated in the progression of MTC. 
      Both drugs are associated with toxicities, including hypertension, 
      hemorrhage/perforation, diarrhea and other gastrointestinal events, several 
      dermatologic events, and hypothyroidism. In addition, vandetanib is uniquely 
      associated with QTc prolongation through interaction with myocardial potassium 
      channels, and cabozantinib is uniquely associated with hand-foot skin reaction. 
      Treatment-related toxicities occur frequently and can be severe or 
      life-threatening, and patients undergoing long-term treatment will likely 
      experience adverse events (AEs). Here we offer specific practical recommendations 
      for managing AEs commonly occurring with vandetanib and cabozantinib. The 
      recommended approach relies on early recognition and palliation of symptoms, dose 
      interruption, and dose reduction as necessary in order for the patient to 
      maintain the highest tolerable dose for as long as possible and optimal quality 
      of life. Treatment guidelines do not specify a recommended sequence for treating 
      with vandetanib and cabozantinib; however, most patients will receive both drugs 
      during their lifetime. The choice for first-line therapy is individualized after 
      a risk-benefit assessment and depends on physician preference and patient-related 
      factors, such as comorbid conditions. Because most generalist practices may not 
      be familiar with the intricacies of agents such as vandetanib and cabozantinib, 
      we commend that patients with advanced MTC be managed and treated by a thyroid 
      cancer specialist with coordination of care within a multidisciplinary team.
CI  - Copyright (c) 2018. Published by Elsevier Ltd.
FAU - Brose, Marcia S
AU  - Brose MS
AD  - Department of Otorhinolaryngology, Head and Neck Surgery and the Abramson Cancer 
      Center, University of Pennsylvania, United States.
FAU - Bible, Keith C
AU  - Bible KC
AD  - Mayo Clinic-Rochester, United States.
FAU - Chow, Laura Q M
AU  - Chow LQM
AD  - University of Washington, United States.
FAU - Gilbert, Jill
AU  - Gilbert J
AD  - Vanderbilt University, United States.
FAU - Grande, Carolyn
AU  - Grande C
AD  - Department of Otorhinolaryngology, Head and Neck Surgery and the Abramson Cancer 
      Center, University of Pennsylvania, United States.
FAU - Worden, Francis
AU  - Worden F
AD  - University of Michigan, United States.
FAU - Haddad, Robert
AU  - Haddad R
AD  - Dana-Farber Cancer Institute, United States. Electronic address: 
      robert_haddad@dfci.harvard.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180422
PL  - Netherlands
TA  - Cancer Treat Rev
JT  - Cancer treatment reviews
JID - 7502030
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Protein Kinase Inhibitors)
RN  - Thyroid cancer, medullary
SB  - IM
MH  - Antineoplastic Agents/*adverse effects/therapeutic use
MH  - Carcinoma, Neuroendocrine/*complications/drug therapy/pathology
MH  - Humans
MH  - Protein Kinase Inhibitors/*adverse effects/therapeutic use
MH  - Thyroid Neoplasms/*complications/drug therapy/pathology
OTO - NOTNLM
OT  - Cabozantinib
OT  - Medullary
OT  - Metastatic
OT  - Multikinase
OT  - REMS
OT  - Vandetanib
EDAT- 2018/04/29 06:00
MHDA- 2018/06/05 06:00
CRDT- 2018/04/29 06:00
PHST- 2017/08/02 00:00 [received]
PHST- 2018/04/12 00:00 [revised]
PHST- 2018/04/20 00:00 [accepted]
PHST- 2018/04/29 06:00 [pubmed]
PHST- 2018/06/05 06:00 [medline]
PHST- 2018/04/29 06:00 [entrez]
AID - S0305-7372(18)30051-3 [pii]
AID - 10.1016/j.ctrv.2018.04.007 [doi]
PST - ppublish
SO  - Cancer Treat Rev. 2018 May;66:64-73. doi: 10.1016/j.ctrv.2018.04.007. Epub 2018 
      Apr 22.