Terapias dirigidas en cáncer de tiroides: una mirada desde la práctica clínica

Terapias dirigidas en cáncer de tiroides: una mirada desde la práctica clínica. A propósito de dos casos

Targeted therapies in thyroid cancer: Insights from clinical practice. Report of two cases

María Dolores Picardo Gomendio*, Irene Grao Torrente*, Ángela Santana Valenciano*, Tamara Díaz Vico*,
Brezo Martínez-Amores Martínez**, Manuel Durán Poveda*

* Unidad de Cirugía Endocrina. Servicio de Cirugía General y del Aparato Digestivo.
     Hospital Rey Juan Carlos, Móstoles, Madrid, España
**  Servicio de Oncología médica.
      Hospital rey Juan Carlos, Móstoles, Madrid, España

DOI: https://doi.org/10.14679/5184

Resumen:

Introducción: La incidencia del cáncer de tiroides ha aumentado, principalmente por la detección temprana mediante ecografía y PAAF. Entre el 10-15% de los casos se presentan como cáncer localmente avanzado (CTLA), asociado a peor pronóstico y mayor morbilidad. La cirugía sigue siendo el tratamiento curativo estándar, pero a veces el tumor es irresecable o su resección conlleva una elevada morbilidad. En estos casos, los inhibidores de tirosina quinasa (ITK) dirigidos contra VEGFR se postulan como una terapia dirigida capaz de reducir la masa tumoral y facilitar la resección completa.
Casos clínicos: Presentamos dos pacientes con CTLA tratadas con inhibidores de tirosina quinasa. En ambos casos, el tratamiento redujo la masa tumoral, permitiendo la resección quirúrgica completa y el posterior tratamiento ablativo con radio yodo.
Discusión: El cáncer de tiroides localmente avanzado sigue siendo un desafío clínico por su morbilidad, riesgo de recurrencia y complejidad quirúrgica. Los inhibidores de tirosina quinasa dirigidos contra VEGFR reducen la masa tumoral y facilitan la resección completa, aunque no están exentos de complicaciones. Su uso debe evaluarse individualmente y en un contexto multidisciplinario. Estudios reportan una tasa de respuesta objetiva del 70,4% y una mediana de supervivencia libre de progresión de 18,3 meses en pacientes refractarios a radio yodo, según el ensayo SELECT.
Conclusión: Aunque la evidencia es limitada, los inhibidores de tirosina quinasa constituyen una estrategia prometedora en el tratamiento del cáncer de tiroides localmente avanzado, facilitando la resección completa.
Palabras Clave: Cáncer de tiroides, terapia neoadyuvante, cáncer de tiroides localmente avanzado, inhibidores de la tirosina quinasa, radio yodo.

Abstract:

Introduction: The incidence of thyroid cancer has increased, mainly due to early detection through ultrasound and fine-needle aspiration biopsy. Between 10-15% of cases present as locally advanced thyroid cancer, associated with poorer prognosis and higher morbidity. Surgery remains the standard curative treatment, but sometimes the tumor is unresectable or associated with high morbidity. In these cases, tyrosine kinase inhibitors targeting VEGFR have been proposed as a targeted therapy capable of reducing tumor burden and facilitating complete resection.
Case Reports: We present two patients with locally advanced thyroid cancer treated with tyrosine kinase inhibitors. In both cases, therapy reduced tumor burden, allowing complete surgical resection followed by ablative radioiodine treatment. Follow-up showed either complete response or prolonged clinical control.
Discussion: Locally advanced thyroid cancer remains a clinical challenge due to morbidity, risk of recurrence, and surgical complexity. Tyrosine kinase inhibitors targeting VEGFR reduce tumor burden and facilitate complete resection, although they are not without complications. Their use should be evaluated individually and within a multidisciplinary context. Published studies report an objective response rate of 70.4% and a median progression-free survival of 18.3 months in radioiodine-refractory patients, according to the SELECT trial.
Conclusion: Although evidence is limited, tyrosine kinase inhibitors represent a promising strategy in the treatment of locally advanced thyroid cancer, facilitating complete surgical resection.
Key words: Thyroid cancer, neoadjuvant therapy, locally advanced thyroid cancer, tyrosine kinase inhibitors, radioactive iodine.

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