Management of treatment-related toxicities in advanced medullary thyroid cancer

Purpose of review Tyrosine kinase inhibitors (TKI), predominantly vandetanib and cabozantinib, are increasingly used for management of advanced medullary thyroid cancer. This review aims to discuss the major and serious adverse events associated with TKI. Recent findings The choice of TKI depends on the patient's existing comorbidities. Patients who have long QT interval should avoid vandetanib and those at risk of gastrointestinal perforation should avoid cabozantinib. Hypertension is common during the first 3 months. Treatments include ACE inhibitors, calcium channel blockers (avoiding verapamil and diltiazem, which are CYP3A4 inhibitors), and beta blockers. Diuretics should be second line because of derangement of electrolytes, which may exacerbate QT interval. As nitric oxide (NO) blockade and ET1 are implicated in the mechanism of hypertension, nitrates and endothelin receptor antagonists may be used. Thromboembolism may require anticoagulation or revascularization procedures. Prolonged QT interval should be treated by dose interruption and reduction, correction of electrolytes, and avoidance of medications, which prolong QTc interval. Diarrhoea is managed symptomatically and with electrolyte replacement, dermatological adverse events with avoidance of exacerbating factors and topical therapies. Thyroid function should be monitored. Summary Toxicities are common with TKI use, and management involves symptomatic treatment, avoidance of triggers, dose interruption,...
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: ENDOCRINE TUMORS: Edited by Christiane Jungels Source Type: research

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ConclusionsProlonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.
Source: Clinical and Experimental Nephrology - Category: Urology & Nephrology Source Type: research
39 y/o with triple-negative breast cancer, 1.9 cm in size, had lumpectomy after neoadjuvant chemo which showed complete response. I'm treating whole breast to 42.6/16. Would anyone omit boost? Thanks.
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Radiation Oncology Source Type: forums
There’s no doubt that the surgical robotics market is getting more crowded the competition is increasing. Intuitive Surgical, a pioneer in the space, is well aware of this fact and took steps this week to boost the da Vinci surgical robot. For an undisclosed sum, the Sunnyvale, CA-based company said it is acquiring the robotic endoscope portion of Schölly Fiberoptic’s business. Schölly Fiberoptic is a player in the field of visualization systems for minimally invasive diagnostic and surgical applications, headquartered in Germany — and one of I...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Digital Health Source Type: news
In this study, we found that calpain was significantly activated in hearts affected by VMC. However, pharmacologically inhibiting calpain aggravated VMC symptoms in mice due to myocardial inflammation and cardiac dysfunction. The inhibition of calpain activity in vitro led to the accumulation of LC3-II and increased levels of p62/SQSTM1 protein expression, suggesting that autophagic flux was impaired by calpain inhibition. These effects of calpain inhibition were also observed in capn4-specific myocardial knockout mice in vivo. Furthermore, our results provided evidence that calpain inhibition in VMC, unlike other cardiova...
Source: Microbes and Infection - Category: Infectious Diseases Source Type: research
Authors: Rustagi N, Pareek P, Verma M, Sharma PK Abstract Quality home-based care for patients with the end-stage disease is increasingly being preferred. Responding to disease associated symptoms and complications may pose an array of challenges in evolving palliative care systems, as no formal institutional mechanism exists to respond to patient and caregiver's wishes. Family and primary care physicians can play an instrumental role in such scenarios by bridging the gaps between cancer specialists and patient and caregivers expectations. PMID: 31304713 [PubMed - in process]
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
Authors: Bochaliya RK, Sharma A, Saxena P, Ramchandani GD, Mathur G Abstract Background: It is accepted that metabolic syndrome increases the relative risk of cardiovascular disease and visceral adiposity lies at root of the cardio-metabolic risk. Upper body fat distribution has long been recognized as associated with metabolic syndrome and increased cardiovascular risk; hence the present study was conducted with the objective to evaluate the association of neck circumference with metabolic syndrome and cardiovascular risk factors. Material and Methods: The present study was a hospital based observational, Desc...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
Alyssa Dyal was 23, a film student in Boston, fooling around with a guy she'd met on a dating app, when everything changed. Within months she was diagnosed with stage 4 breast cancer.
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
ConclusionIn conclusion, this study showed that Aloe vera extract and its active component aloin activated the Wnt/β-catenin pathway and inhibited the Notch pathway in the presence of Wnt3a. While another active component, aloesin, activated the Wnt/β-catenin pathway and inhibited the Notch signaling pathway independent of Wnt3a. Given that Wnt/β-catenin and Notch pathway are closely associated with the progression of CRC, these findings would be helpful to better understand the colonic carcinogenicity of Aloe vera.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
XPOVIO is a drug used to treat a form of blood cancer called multiple myeloma. It is to be used in combination with dexamethasone (a type of corticosteroid) in patients with no other treatment options whose cancer came back after, or did not respond to, at least four previous treatments.
Source: FDA Center for Drug Evaluation and Research - What's New - Category: Drugs & Pharmacology Authors: Source Type: news
Authors: Li X, Wei Y, Shao H, Peng L, An C, Yu MA Abstract Objective: To assess the feasibility of microwave ablation (MWA) in treating ectopic secondary hyperparathyroidism (SHPT) in patients with chronic renal failure. Methods: In this retrospective study, MWA was used to manage 22 SHPT nodules in 20 patients. The laboratory test results, including intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels; clinical symptoms; complications before, at one day after MWA, and at the end of follow-up were recorded and compared. Both echogenicity and size of SHPT nodules ...
Source: International Journal of Hyperthermia - Category: Internal Medicine Tags: Int J Hyperthermia Source Type: research
More News: Beta-Blockers | Calcium | Cancer | Cancer & Oncology | Dermatology | Diarrhoea | Diltiazem | Gastroenterology | Hypertension | Skin | Thrombosis | Thyroid | Thyroid Cancer | Toxicology | Verapamil