The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring

The noninvestigational use of tyrosine kinase inhibitors in thyroid cancer: establishing a standard for patient safety and monitoring.Carhill AA, Cabanillas ME, Jimenez C, Waguespack SG, Habra MA, Hu M, Ying A, Vassilopoulou-Sellin R, Gagel RF, Sherman SI, Busaidy NL. J Clin Endocrinol Metab. 2013 Jan;98(1):31-42
The increasing use of tyrosine kinase inhibitor therapy outside of the context of the clinical trial for treatment of advanced thyroid cancer has highlighted the need for a systematic approach to the clinical application of these agents in order to improve patient safety and monitoring promote consistency among providers, and ensure compliance with both institutional and industry standards. We reviewed professional thyroid cancer guidelines, the National Comprehensive Cancer Network task force reports, American Society of Clinical Oncology safety standards, review articles, and clinical trials published within the past 10 yr and also included relevant older studies. Review of available published data and the collective experience prescribing tyrosine kinase inhibitors at The University of Texas MD Anderson Cancer Center have highlighted the need for a systematic, comprehensive, and uniform approach to managing these patients. This paper discusses the approach adopted by the Department of Endocrine Neoplasia at the MD Anderson Cancer Center and illustrates practice patterns, experience, and our standardized approach related to prescribing commercially available tyrosine kinase inhibitors outside of the context of a clinical trial for patients with advanced thyroid cancer.
COMMENT-Tyrosine kinase inhibitors play an increasing role in management of thyroid cancer. This article concentrates on how to establish standard guidelines for their use within an institution. But in the process is describes in considerable detail the history of use of Sorafenib, Sunitinib, Pazopanib, and Vandetanib, as well as their extensive and serious side effects, which are summarized in tabular form. This is a very useful reference for thyroidologists and others using these new drugs, especially those without extensive prior experience. L De Groot, MD

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