甲状腺髓样癌的分子分型及治疗讲解课件.ppt

Medical Management of Advanced Metastatic Disease ④Targeted therapy Tyrosine kinase inhibitors(TKIs)-- RET, EGFR, VEGFR, and FGFR, MET  Two small-molecule TKIs, vandetanib (Apr 2011) and cabozantinib(Nov 2012), are currently available as approved agents for the treatment of advanced or progressive MTC and provide significant increases in progression-free survival (PFS).  Medical Management of Advanced Metastatic Disease ●Vandetanib--RET, EGFR, VEGFR and EGFR ⅰtwo phase 2 (hereditary only)  dose daily 300 mg 100 mg PR 20% 16% stable disease 53% 53% median PFS 27.9 months 24 weeks ⅱphase 3 in 331 patients (H-S-MTC) 300mg/d; objective response rate (ORR) 45%; median PFS 30.5 months.  QT prolongation (14%),diarrhea (56%), rash (45%), hypertension (32%), headache (26%)…. Medical Management of Advanced Metastatic Disease ●Cabozantinib--RET, VEGFR and c-MET less suitable for elderly patients for whom the prevalence of cardiovascular risk factors  The estimated median PFS with vandetanib is numerically longer than with cabozantinib  Choice: The patient’s comorbid conditions and the toxicity profile that the patient is willing to bear  Medical Management of Advanced Metastatic Disease ●other small-molecule kinase inhibitors sunitinib, sorafenib, and pazopanib  ●Other targeted treatments mammalian target of rapamycin (mTOR) inhibitor -everolimus  Prevention-PD/PGD Preimplantation genetic diagnosis of multiple endocrine neoplasia type 2A using informative markers identified by targeted sequencing[J], Thyroid, 2017. (UR) Acknowledgement 甲状腺髓样癌的分子分型及治疗 解放军第一一七医院 戚晓平 概况 Histologic subtypes of thyroid cancer ①Papillary: approximately 80% of all thyroid malignancies;  ②Follicular and Hürthle: approximately 11%;  ③Medullary: less than 5%-8% ; ④Anaplastic: less than 2%.  Introducti