Efficacy and safety of treatments used in differentiated thyroid cancer (DTC): A systematic review
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Abstract
Patients diagnosed with differentiated thyroid cancer (DTC) are offered multiple targeted therapeutics, but it is unclear which pharmaceutical therapies are most effective and safe. A systematic literature review (SLR) was performed to assess the clinical efficacy and safety of targeted therapeutics in DTC patients. A comprehensive search was performed across MEDLINE®, Embase®, and Evidence-based Medicine (EBM) Reviews databases, along with grey literature search. Eighteen studies that met the inclusion criteria were identified from 5,334 publications. Two studies assessed treatments in the DTC population, whereas 16 addressed the radioactive iodine resistant (RAIR) sub-population. In DTC patients, nintedanib led to a modest increase in progression-free survival (PFS) compared to placebo (3.71 months vs 2.86 months). Selumetinib with radioactive iodine had minimal impact on complete remission rates (40 vs. 38%) but raised concerns due to adverse events (AEs). In the RAIR sub-population, various treatments, including donafenib, lenvatinib, anlotinib, apatinib, cabozantinib, cediranib, dabrafenib+trametinib, sorafenib, pazopanib, and vandetanib, demonstrated clinical benefits, ranging from 2% (intermittent pazopanib) to 69.9% (lenvatinib). Furthermore, cabozantinib significantly improved PFS compared to placebo, with anlotinib reaching a remarkable 40.54 months. AEs, predominantly grade 1-2, have been reported across studies, with hypertension, diarrhea, and skin reactions being common. While lenvatinib was effective, it had a high AE rate of 75.9% (grade 3). Despite modest progress in the general DTC population, lenvatinib has revolutionized RAIR-DTC treatment by delivering a higher response rate and extended survival, albeit with a higher risk of AEs. Therefore, further research is needed to enhance the understanding and outcomes of both DTC and RAIR-DTC.
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