Expert consensus on the management of adverse events in patients receiving targeted agents for advanced thyroid cancer (2023 edition)

doi:10.19401/j.cnki.1007-3639.2023.09.009

Abstract

Abstract:

Recently, targeted therapy has become the standard of care for advanced thyroid cancer. Although expert consensus on the management of adverse events in patients receiving targeted agents for radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) was formulated by Thyroid Cancer Committee of Chinese Society of Clinical Oncology in 2018, the tumor types which are eligible for targeted therapy have been extended to medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC), and targeted agents have been approved from multikinase inhibitors (MKIs) to BRAF inhibitors, MEK inhibitors, RET inhibitors and TRK inhibitors. Along with the widely used targeted agents with different mechanism, the management of adverse events for targeted agents needs to be standardized and improved, especially considering the specialties of the physicians who are involved in the targeted therapy for thyroid cancer are variable. Therefore, Thyroid Cancer Committee of Chinese Society of Clinical Oncology convened an expert task force charged with developing consensus to serves as a guidance to standardize utilization of targeted agents and to optimize clinical practice.

Key words: Advanced thyroid cancer, Targeted agents, Adverse events, Expert consensus

CLC Number:

R736.1

XUE Liqiong, GUO Ye, CHEN Libo. Expert consensus on the management of adverse events in patients receiving targeted agents for advanced thyroid cancer (2023 edition)[J]. China Oncology, 2023, 33(9): 879-888.

Figures/Tables 11

References 35

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项目	索拉非尼^[7]（n = 207）	仑伐替尼^[8]（n = 103）	多纳非尼^[9]（n = 128）	安罗替尼^[11]（n = 62）
3/4级不良反应	64.3	87.4	43.8	58.1
严重不良反应	37.2	38.8	7.8	12.9
剂量下调	64.3	80.6	42.2	32.3
治疗暂停	66.2	67.0	42.2	NR
治疗终止	18.8	8.7	6.3	16.1

不良反应	索拉非尼^[7]（n = 207）		仑伐替尼^[8]（n = 103）		多纳非尼^[9]（n = 128）		安罗替尼^[10-11]（n = 138）
不良反应	任意级别	≥3级	任意级别	≥3级	任意级别	≥3级	任意级别	≥3级
HFSR	76.3	20.3	58.3	9.7	84.4	12.5	68.8	16.7
高血压	40.6	9.7	81.6	62.1	46.9	13.3	67.4	28.9
腹泻	68.6	5.8	49.5	6.8	63.3	3.1	42.7	6.5
蛋白尿	NR	NR	80.6	23.3	38.3	1.6	63.0	2.9
体重下降	46.9	5.8	47.6	2.9	34.4	1.6	26.1	5.1
食欲下降	31.9	2.4	20.4	1.9	14.8	0.8	30.4	0.7
谷丙转氨酶升高	12.6	2.9	NR	NR	14.1	1.6	35.5	0.7
谷草转氨酶升高	11.1	1.0	NR	NR	10.9	0.8	28.3	0.7
低钙血症	18.8	9.2	29.1	3.9	22.7	3.1	NR	NR

项目	ATC^[15]（n= 36）	RAIR-DTC^[16]（n= 27）
3/4级不良反应	58	48
严重不良反应	19	NR
剂量下降	47	56
治疗暂停	50	NR
治疗终止	17	22

不良反应	普拉替尼^[17]（n = 28）		赛普替尼^[18]（n = 77，其中30例为甲状腺癌）
不良反应	任意级别	≥3级	任意级别	≥3级
高磷血症	57.1	0.0	NR	NR
白细胞减少	57.1	14.3	31.2	3.9
中性粒细胞减少	53.6	28.6	24.7	3.9
谷草转氨酶水平升高	53.6	0.0	61.0	15.6
乳酸脱氢酶水平升高	50.0	0.0	20.8	0.0
肌酸激酶水平升高	46.4	21.4	NR	NR
谷丙转氨酶水平升高	42.9	3.6	62.3	15.6
低钙血症	39.3	10.7	NR	NR
胆红素升高	NR	NR	39.0	0.0
血小板减少	NR	NR	37.7	10.4
贫血	35.7	10.7	NR	NR
高血压	25.0	10.7	33.8	15.6
低白蛋白血症	28.6	0.0	26.0	1.3
腹泻	NR	NR	28.6	1.3
血肌酐水平升高	25.0	0.0	23.4	0.0
高尿酸血症	NR	NR	20.8	0.0

不良反应	拉罗替尼^[19]（n = 30）		恩曲替尼^[21]（n = 68，其中5例为甲状腺癌）
不良反应	任意级别	≥3级	任意级别	≥3级
疲劳	26.7	0	35	7
头晕	26.7	0	26	2
谷草转氨酶水平升高	26.7	0	12	2
谷丙转氨酶水平升高	26.7	0	11	2
肌肉痛	26.7	0	12	0
味觉障碍	NR	NR	47	0
便秘	16.7	0	28	0
腹泻	10.0	0	29	2
外周水肿	13.3	0	26	2