Faculty Collaboration Database

Tumor marker and measurement fluctuations may not reflect treatment efficacy in patients with medullary thyroid carcinoma on long-term RET inhibitor therapy. Ann Oncol 2013 Sep;24(9):2256-61

Date

05/17/2013

Pubmed ID

23676418

DOI

10.1093/annonc/mdt177

Scopus ID

2-s2.0-84883414362 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

BACKGROUND: RET kinase inhibitors have significant activity in patients with medullary thyroid carcinoma (MTC).

PATIENTS AND METHODS: We retrospectively reviewed the electronic medical record for patterns of calcitonin, carcinoembryonic antigen (CEA) and tumor measurement responses in consecutive patients with MTC who received treatment with a RET inhibitor for at least 6 months.

RESULTS: Twenty-six patients who received RET kinase inhibitors for at least 6 months were included. All patients experienced an initial decline in calcitonin; 20 (77%) demonstrated later fluctuations in calcitonin, which spiked above baseline levels in 9 individuals (35%). Twenty of the 22 patients (91%) with elevated CEA experienced a decline with treatment, with 11 individuals (50%) later demonstrating transient fluctuations in CEA, including spikes above baseline in 7 patients (32%). Ten of the 26 patients (38%) also demonstrated short-lived fluctuations in RECIST measurements, including changes of over 20% from nadir values. Vacillations in calcitonin, CEA and measurements often occurred repeatedly in individual patients and did not regularly correlate with each other.

CONCLUSIONS: Repeated transient fluctuations in tumor markers and measurements are a characteristic of patients with MTC receiving treatment with RET inhibitors, and such short-term vacillations may not reflect responsiveness over the long term.

CLINICAL TRIALS INCLUDED: NCT00215605; NCT00244972; NCT00121680; NCT00495872.

Author List

Kurzrock R, Atkins J, Wheler J, Fu S, Naing A, Busaidy N, Hong D, Sherman S

Author

Razelle Kurzrock MD Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anilides
Antineoplastic Agents
Biomarkers, Tumor
Calcitonin
Carcinoembryonic Antigen
Carcinoma, Neuroendocrine
Disease Progression
Female
Humans
Indoles
Male
Middle Aged
Niacinamide
Phenylurea Compounds
Proto-Oncogene Proteins c-ret
Pyridines
Pyrroles
Quinolines
Quinolones
Retrospective Studies
Thyroid Neoplasms
Treatment Outcome
Valproic Acid