ABSTRACT
RESUMEN Las metástasis a distancia ocurren en alrededor del 10% de los pacientes con cáncer diferenciado de tiroides (CDT), y cerca de la mitad de estos casos serán refractarios al radioyodo (RAIR). Sorafenib fue el primer inhibidor multicinasa (IMK) aprobado por la FDA para su uso en cáncer diferenciado de tiroides RAIR avanzado y progresivo, y hasta el momento es el único aprobado por la ANMAT en nuestro país para esta indicación. Lenvatinib es el segundo IMK aprobado por la FDA para este grupo de pacientes, y es una alternativa terapéutica que debe ser considerada, debido a su disponibilidad como fármaco de uso compasivo en nuestro país. Presentamos nuestra experiencia con el uso de lenvatinib como segunda línea de tratamiento en una paciente con CDT progresivo previamente tratado con sorafenib.
ABSTRACT Distant metastases occur in around 10% of patients with differentiated thyroid cancer (DTC), and half of these cases will become refractory to radioiodine therapy (RAIR). Sorafenib was the first multikinase inhibitor (MKI) approved by the FDA for patients with differentiated advanced and progressive RAIR thyroid cancer, and it is the only one approved by ANMAT in our country for this indication. Lenvatinib is the second MKI approved by the FDA for this group of patients, and is a therapeutic alternative that should be considered, due to its availability as a compassive use drug in our country. We present our experience with the use of lenvatinib as a second line of treatment in a patient with DTC with advanced and progressive disease under treatment with sorafenib.
Subject(s)
Humans , Female , Aged , Serum Albumin, Radio-Iodinated/adverse effects , Thyroid Neoplasms/drug therapy , Sorafenib/adverse effects , Serum Albumin, Radio-Iodinated/radiation effects , Sorafenib/therapeutic useABSTRACT
Mice injected with 131I-human albumin microspheres equivalent to 10-20 or 200 human doses were sequentially killed over a 12-day period. About 90% of the microspheres initially lodged in the precapillary arterioles and capillaries of the lungs. Their pulmonary clearance was essentially complete after 3 days. Occlusion of the vessels always led to focal hyperemia of the surrounding tissue and to slight hemorrhage into the alveoli. This was followed, though less frequently, by perivascular nodular inflammtion. Hemorrhagic infarcts were quite uncommon and occurred only after the massive doses. Some emboli underwent organization, but most were resolved. Circulatory disturbances and perivascular inflammation receded in about 1 week and seldom led to obliteration of the involved vessels. Hemorrhagic infarcts were converted into minute scars. Twelve days after injection of microspheres in massive doses, the only findings were post-inarct scars and obliterated vessels, which were sparse and difficult to detect. The lower doses of microspheres did not leave any detectable residues.
Subject(s)
Lung/pathology , Microspheres , Serum Albumin, Radio-Iodinated/adverse effects , Animals , Capillaries/drug effects , Female , Hemorrhage/chemically induced , Humans , Hyperemia/chemically induced , Mice , Mice, Inbred Strains , Pulmonary Circulation/drug effects , Pulmonary Edema/chemically induced , Pulmonary Embolism/chemically inducedABSTRACT
This review covers the side effects and adverse reactions to radiopharmaceuticals that were reported in the literature over the past 25 years. The information published prior to 1970 is sporadic, but due to the increased utilization of nuclear medicine procedures and the recognition that radiopharmaceuticals may have pharmacologic side effects, a registry has existed since 1971 to tabulate information on such effects. This survey is medical, rather than pharmaceutical in emphasis and so the adverse reactions are classified according to the target-organ systems involved rather than according to the specific radionuclides or to pharmaceuticals. If any of the radiopharmaceuticals of present or past use are not mentioned in this review, it is because no reports on their side effects were retrived by us. Hopefully, the organized registry system suggested by the Society of Nuclear Medicine (SNM) will enable a more complete recording of side effects from radiopharmaceuticals in the future.
Subject(s)
Radioisotopes/therapeutic use , Radionuclide Imaging/adverse effects , Radiotherapy/adverse effects , Bone Marrow/drug effects , Bone Marrow/radiation effects , Brain Diseases/diagnosis , Colloids/adverse effects , Gold Colloid, Radioactive/adverse effects , Humans , Hyperthyroidism/radiotherapy , Iodine Radioisotopes/adverse effects , Iron/adverse effects , Kidney Diseases/diagnosis , Liver Diseases/diagnosis , Lung Diseases/diagnosis , Meningitis/chemically induced , Peritoneum/radiation effects , Phosphorus Radioisotopes/adverse effects , Polycythemia Vera/radiotherapy , Pyrogens , Registries , Serum Albumin/adverse effects , Serum Albumin, Radio-Iodinated/adverse effects , Skin/radiation effects , United States , Xenon Radioisotopes/adverse effectsABSTRACT
The role of pyrogens in aseptic meningitis after radionuclide cisternography was studied by means of the Limulus test, a sensitive detector of endotoxin. During a 15-month period, 39 reactions associated with cisternography were reported. Ten samples of specific lots of the radioactive drugs implicated in 20 of these reactions were tested and all reacted strongly positive to the Limulus test. The less sensitive rabbit pyrogen test was negative for these preparations when tested on a dose-per-weight basis. Our findings apparently provide clinical evidence for the observation made in animals that endotoxin is at least 1,000 times more toxic intrathecally than intravenously. The data implicate endotoxin contamination as a cause of adverse reactions to radionuclide cisternography. We conclude that the USP pyrogen test is insufficiently sensitive for intrathecal injectables and should be supplemented by the Limulus test.
