EP143 – Efficacy of low dose sorafenib in advanced differentiated non-Iodine concentrating thyroid cancer

      Barai, S.1; Ora, Manish1; Gambhir, S.1; Kumar, N.1 1 Department of Nuclear Medicine, Sanjay Gandhi postgraduate Institute of Medical Sciences, Lucknow, India   Background/purpose:  Sorafenib, an antivascular endothelial growth factor tyrosine kinase inhibitors have been used recently in the treatment of advanced differentiated thyroid cancer (DTC), however many patient cannot tolerate the high incidence of adverse effect1.  Aim of the study was to evaluate patient tolerability and effectiveness of a low dose sorafenib therapy protocol. Patients and methods:  Patients with non-Iodine concentrating advanced DTC having elevated and rising thyroglobulin level were enrolled in the study.  Patients were put on a low dose sorafenib(400mg/day) as against the standard dose of 800mg/day. Clinical evaluations were done at 3, 21 days and 6 month. Thyroglobulin levels were repeated at 6th month. A patient demonstrating any increasel in Thyroglobulin level on sorafenin was considered as non-responder. Results:  Fourteen patients (9 males and 5 females) were enrolled in this study having a mean age of 47±13.1 years (range: 28–63 years). Histological variants were follicular [n] =10; hurthle cell variant n=2, tall cell variant n=2. Drug was discontinued in 1 patient due to development of gastro-intestinal bleeding. Two additional patients developed itching which responded well to conservative therapy. Fall in thyroglogulin level was noted in 11(78.5%) patients with pre-therapy and post-therapy thyroglobulin levels were 1967 ± 642 ng/mL, and 497 ± 113 ng/mL respectively (p<0.01). However there was no complete response. Stable level was noted in one patient, and where an increase in thyroglobulin was noted in one patient. Conclusion: Sorafenib is  reasonably well-tolerated treatment in advanced thyroid cancers even in reduced dose of 400mg/day.   References:
    1. Jean GW, Mani RM, Jaffry A, Khan SA. Toxic Effects of Sorafenib in Patients With Differentiated Thyroid Carcinoma Compared With Other Cancers. JAMA Oncol. 2016; 2:529-34.


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