Thyroid Dysfunction in RCC

George Yaghmour

Aug 18, 2015

Very interesting point to discuss. Literatures review has a conflicts about the survival prognostic role of hypothyroidism in mRCC treated with TKIs. No clear, and limited date to address whether to continue or stop the TKIs. Hypothyroidism in patients with metastatic renal cell carcinoma (mRCC) during treatment with the tyrosine kinase inhibitors (TKIs) sunitinib and sorafenib is a well-established side effect. Furthermore, the potential role of hypothyroidism as predictive marker of outcome has been studied but with conflicting results. Daimon et al, reported that patients treated with the tyrosine kinase inhibitors developed thyroid dysfunction frequently. Furthermore, those treated with axitinib developed thyroid dysfunction significantly more and at a faster rate than the others.  Bailey et all addressed the severity of VEGFR-TKI therapy-associated hypothyroidism (TSH > 10 mIU/L) was associated with improved survival outcomes in patients with mRCC and should not necessitate a dose reduction or therapy discontinuation . However, Nearchou et al, meta analysis reported that the development of hypothyroidism during TKI therapy is not clearly shown to be predictive in patients with mRCC. The observed advantage in OS for the patients with hypothyroidism should be interpreted with caution; however, enhanced immune response could be the answer to this conflict. Pending prospective study with a suitable study design would  give a definite answer as to whether hypothyroidism can serve as predictive marker for treatment efficacy of TKIs in patients with mRCC.