RESUMO
Even though differentiated thyroid carcinoma is a slow growing and usually curable disease, recurrence occurs in 20-40% and cellular dedifferentiation in up to 5% of cases. Conventional chemotherapy and radiotherapy have just a modest effect on advanced thyroid cancer. Therefore, dedifferentiated thyroid cancer represents a therapeutic dilemma and a critical area of research. Targeted therapy, a new generation of anticancer treatment, is planned to interfere with a specific molecular target, typically a protein that is believed to have a critical role in tumor growth or progression. Since many of the tumor-initiation events have already been identified in thyroid carcinogenesis, targeted therapy is a promising therapeutic tool for advanced thyroid cancer. Several new drugs are currently being tested in in vitro and in vivo studies and some of them are already being used in clinical trials, like small molecule tyrosine kinase inhibitors. In this review, we discuss the bases of targeted therapies, the principal drugs already tested and also options of redifferentiation therapy for thyroid carcinoma.
Assuntos
Carcinoma Papilar, Variante Folicular/terapia , Inibidores de Proteínas Quinases/farmacologia , Proteínas Tirosina Quinases/antagonistas & inibidores , Neoplasias da Glândula Tireoide/terapia , Antineoplásicos/uso terapêutico , Carcinoma Papilar, Variante Folicular/tratamento farmacológico , Carcinoma Papilar, Variante Folicular/radioterapia , Ensaios Clínicos como Assunto , Humanos , Radioisótopos do Iodo/uso terapêutico , Proteínas Tirosina Quinases/uso terapêutico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/radioterapiaRESUMO
Even though differentiated thyroid carcinoma is a slow growing and usually curable disease, recurrence occurs in 20-40 percent and cellular dedifferentiation in up to 5 percent of cases. Conventional chemotherapy and radiotherapy have just a modest effect on advanced thyroid cancer. Therefore, dedifferentiated thyroid cancer represents a therapeutic dilemma and a critical area of research. Targeted therapy, a new generation of anticancer treatment, is planned to interfere with a specific molecular target, typically a protein that is believed to have a critical role in tumor growth or progression. Since many of the tumor-initiation events have already been identified in thyroid carcinogenesis, targeted therapy is a promising therapeutic tool for advanced thyroid cancer. Several new drugs are currently being tested in in vitro and in vivo studies and some of them are already being used in clinical trials, like small molecule tyrosine kinase inhibitors. In this review, we discuss the bases of targeted therapies, the principal drugs already tested and also options of redifferentiation therapy for thyroid carcinoma.
Apesar de o carcinoma diferenciado da tireóide ser considerado uma doença de curso indolente e geralmente curável, recorrência tumoral ocorre em aproximadamente 20 a 40 por cento e desdiferenciação celular, em até 5 por cento dos casos. A quimioterapia convencional e a radioterapia apresentam apenas um modesto efeito sobre o câncer de tireóide avançado. Dessa forma, o carcinoma da tireóide desdiferenciado representa um dilema terapêutico e uma importante área de pesquisa. A terapia direcionada, uma nova geração de tratamento para o câncer, tem como objetivo interferir com um alvo molecular específico, geralmente uma proteína considerada fundamental para o crescimento e progressão tumoral. Como muitos eventos iniciadores do processo de carcinogênese tireoideana já foram identificados, a terapia direcionada representa uma promissora opção terapêutica para o carcinoma da tireóide avançado. Várias drogas novas estão em estudos in vitro e in vivo e algumas já estão sendo testadas em estudos clínicos, como as pequenas moléculas inibidoras de tirosina cinase. Nesta revisão, as bases moleculares da terapia direcionada, as principais drogas utilizadas e as opções terapêuticas de rediferenciação do carcinoma da tireóide serão discutidas.