PMID- 38351437 OWN - NLM STAT- MEDLINE DCOM- 20240307 LR - 20240405 IS - 1365-2265 (Electronic) IS - 0300-0664 (Linking) VI - 100 IP - 4 DP - 2024 Apr TI - Tyrosine kinase inhibitors for radioiodine refractory differentiated thyroid cancer: A systematic review and meta-analysis. PG - 379-388 LID - 10.1111/cen.15027 [doi] AB - BACKGROUND: The poor overall prognosis of radioiodine refractory thyroid cancer is an inevitable challenge in managing this disease. A series of trials have demonstrated the antitumor activity of tyrosine kinase inhibitors (TKIs) in radioiodine refractory differentiated thyroid cancer (RAIR-DTC). However, the available evidence cannot determine the optimal choice of TKI in RAIR-DTC. METHODS: This study searched PubMed, EMBASE, Cochrane databases, and the ClinicalTrials website. The Cochrane bias risk tool was used to assess the risk of bias, and to evaluate randomized clinical trials (RCT) of RAIR-DTC patients treated with the TKI system. Outcomes, including progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were reported. RESULTS: Seven studies involving 1310 patients with RAIR-DTC was conducted to compare the PFS and OS of various TKI monotherapies with placebo. The results showed that all TKI monotherapies had a statistically significant benefit in terms of PFS compared with placebo, with lenvatinib demonstrating the greatest benefit (hazard ratio [HR] 0.19, 95% credible interval [CrI] 0.14-0.25). In terms of OS, only apatinib (HR 0.42, 95% CrI 0.18-0.97) and anlotinib (HR 0.36, 95% CrI 0.18-0.73) showed statistically significant benefits compared with placebo. TKIs also had a higher incidence of AEs of grade 3 or higher compared with placebo. The findings suggest that lenvatinib may be the preferred TKI for the treatment of RAIR-DTC, although its high incidence of AEs should be considered. The results also indicate that TKI treatment may be similarly effective in RAIR-DTC patients with BRAF or RAS mutations and in those with papillary or follicular subtypes of the disease, regardless of prior TKI treatment. CONCLUSIONS: The results of this meta-analysis suggest that targeted therapy with TKIs may be beneficial for patients with radioiodine-refractory advanced or metastatic differentiated thyroid cancer. Among the TKIs analyzed, lenvatinib appeared to be the most effective at improving PFS, although it also had the highest incidence of AEs. Further research through direct randomized controlled trials is needed to determine the optimal choice of TKI for treating patients with RAIR-DTC. This study is beneficial for formulating patients' treatment plans and guides clinicians' decision-making. CI - (c) 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd. FAU - Yu, Jiayi AU - Yu J AD - Department of oncology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P. R. China. FAU - Liu, Zheran AU - Liu Z AD - Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Su, Yonglin AU - Su Y AD - Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, China. FAU - Peng, Xingchen AU - Peng X AUID- ORCID: 0000-0001-7042-718X AD - Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. FAU - Xie, Yuping AU - Xie Y AD - Department of oncology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P. R. China. LA - eng GR - CGZH19002/Translational medicine fund of West China Hospital/ GR - 2020HXBH119/Translational medicine fund of West China Hospital/ GR - HXHL21008/West China Nursing Discipline Development Special Fund Project/ GR - 2020YFS0276/Sichuan Province Science and Technology Support grant and TianFu Laboratory/ GR - 2022SYSX0064/Sichuan Province Science and Technology Support grant and TianFu Laboratory/ GR - 2021YFSY0008/Sichuan Province Science and Technology Support grant and TianFu Laboratory/ GR - 81672386/National Natural Science Foundation of China/ GR - 82172842/National Natural Science Foundation of China/ GR - 2020HXBH119/Post-Doctor Research Project, West China Hospital, Sichuan University/ GR - 2021YFE0206600/The National Key Research and Development Program of China/ PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20240213 PL - England TA - Clin Endocrinol (Oxf) JT - Clinical endocrinology JID - 0346653 RN - 0 (Antineoplastic Agents) RN - 0 (Iodine Radioisotopes) RN - EE083865G2 (lenvatinib) RN - 0 (Phenylurea Compounds) RN - 0 (Quinolines) RN - 0 (Tyrosine Kinase Inhibitors) SB - IM MH - Humans MH - *Antineoplastic Agents/therapeutic use MH - Iodine Radioisotopes/therapeutic use MH - Phenylurea Compounds/therapeutic use MH - *Quinolines MH - *Thyroid Neoplasms/pathology MH - Tyrosine Kinase Inhibitors OTO - NOTNLM OT - differentiated thyroid cancer OT - meta-analysis OT - systematic review OT - tyrosine kinase inhibitors EDAT- 2024/02/14 06:43 MHDA- 2024/03/07 06:42 CRDT- 2024/02/14 00:04 PHST- 2023/12/08 00:00 [revised] PHST- 2022/10/11 00:00 [received] PHST- 2024/01/24 00:00 [accepted] PHST- 2024/03/07 06:42 [medline] PHST- 2024/02/14 06:43 [pubmed] PHST- 2024/02/14 00:04 [entrez] AID - 10.1111/cen.15027 [doi] PST - ppublish SO - Clin Endocrinol (Oxf). 2024 Apr;100(4):379-388. doi: 10.1111/cen.15027. Epub 2024 Feb 13.