Endocrinol Metab.  2014 Sep;29(3):388-393. 10.3803/EnM.2014.29.3.388.

Accelerated Disease Progression after Discontinuation of Sorafenib in a Patient with Metastatic Papillary Thyroid Cancer

• Yun KJ
• Kim W
• Kim EH
• Kim MH
• Lim DJ
• Kang MI
• Cha BY

• KMID: 2169477
• DOI: http://doi.org/10.3803/EnM.2014.29.3.388

Abstract

Distant metastases from papillary thyroid carcinoma (PTC) are rare and are associated with a poor prognosis. Here, we describe a patient with metastatic PTC who was treated with a tyrosine kinase inhibitor (TKI, sorafenib) for several months that was acutely exacerbated by discontinuation. A 43-year-old male was diagnosed with PTC in February 2004 and underwent total thyroidectomy followed by two courses of high-dose radioactive iodine (RAI) therapy. Despite two additional courses of high-dose RAI therapy, lung and muscle metastases were developed. Treatment with sorafenib was begun in September 2010. After 11 months treatment of sorafenib, newly developed metastatic lesions were found in mediastinal lymph nodes, liver, and bones. Considered as treatment failure, the administration of sorafenib was discontinued. Two weeks after sorafenib treatment was stopped, the disease progressed abruptly and caused death of the patient by respiratory failure. In our patient, PTC progressed rapidly after the cessation of sorafenib treatment. Patients with several other types of cancer have also experienced such rapid disease progression, termed "flare-ups." Physicians should be aware that flare-ups may occur in advanced PTC patients following the cessation of TKI therapy.

Keyword

Thyroid neoplasms; Papillary; Neoplasm metastasis; Sorafenib

MeSH Terms

Adult
Disease Progression*
Humans
Iodine
Liver
Lung
Lymph Nodes
Male
Neoplasm Metastasis
Prognosis
Protein-Tyrosine Kinases
Respiratory Insufficiency
Thyroid Neoplasms*
Thyroidectomy
Treatment Failure
Iodine
Protein-Tyrosine Kinases

Figure

• 

  Fig. 1 (A) A chest computed tomography (CT) and (B) abdominal CT before the administration of sorafenib showed multiple hematogenous metastases in both lungs and a 1.8-cm enhancing metastatic lesion in the right gluteus muscle. (C, D) After 2 months of sorafenib treatment, slight decreases in the sizes of the metastatic lesions in both lungs and the right gluteus muscle were noticed. (E) Two weeks after cessation of sorafenib, a follow-up chest CT revealed a marked progression of hemolymphatic metastasis and the development of pleural metastasis with bilateral pleural effusion.

• 

  Fig. 2 (A) A histopathological examination of the right gluteus muscle lesion showed papillary architecture (H&E stain, ×200). (B) Immunohistochemical staining showed strong thyroid transcription factor-1 immunoreactivity (×400).

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  Fig. 3 (A) A histopathological examination of the liver revealed the anaplastic transformation of follicular cell-derived thyroid carcinoma (H&E stain, ×200). (B) Immunohistochemical staining showed strong immunoreactivity with CK-7 (×400), (C) galectin-3 (×400), (D) human mesothelial cell-1 (×400), and (E) thyroid transcription factor-1 (×400).

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