Emerging role of multikinase inhibitors for refractory thyroid cancer

Cesar A Perez,1 Belisario A Arango,1 Michel Velez,1 Luis E Raez,2 Edgardo S Santos11University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, USA; 2Memorial Cancer Institute, Memorial Health Care System, Hollywood, FL, USAAbstract: Thyroid cancer incidence continues to increase, remaining the most common endocrine malignancy. The need for effective systemic therapies combined with high incidence of driver mutations and overexpression of molecular pathways make refractory thyroid cancer an ideal candidate for treatment with novel agents. Multikinase inhibitors have caused a paradigm shift in the treatment of patients with advanced iodine-refractory thyroid cancer. These agents have shown to be the most effective systemic therapy for this disease not only causing prolonged responses but also improving survival. The activity of these agents inhibiting several pathways simultaneously, such as rearranged during transfection protooncogene, mitogen-activated protein kinase, and angiogenesis, can probably explain the effectiveness in controlling the progression of this malignancy. Several of these agents are currently on clinical studies in patients with differentiated and medullary thyroid cancer and most of them are showing promising clinical activity. With the approval of vandetanib for the treatment of medullary thyroid cancer, a new era in the management of this disease has begun. The molecular rationale for the use of these drugs for thyroid cancer is discussed as well as their promising clinical results.Keywords: axitinib, cabozantinib, lenvatinib, mitogen-activated protein kinase (MAPK), motesanib, pazopanib, thyroid cancer, vandetanib, vascular endothelial growth factor receptor-2 (VEGFR2