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Isotretinoin in Metastatic Thyroid Cancer
- Anne R. Borner, MD;
- Dietmar Simon, MD; and
- Hans W. Muller-Gartner, MD
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TO THE EDITOR:
Although excellent results with 13-cis-retinoic acid (isotretinoin) have been reported in acute promyelocytic leukemia [1], the role of isotretinoin has not been fully established in the treatment of other malignancies. Oxyphilic follicular thyroid cancer is associated with a poor prognosis compared with other differentiated thyroid tumors [2]. No cure is known for metastatic disease. Spontaneous tumor regression in differentiated thyroid cancer is extremely rare. Influences on iodine metabolism, induction of 5′ deiodinase, and decreased proliferation in follicular thyroid cancer cells have been observed [3-5].
In May 1993, a 72-year-old man presented with an oxyphilic follicular thyroid cancer with lymph node and pulmonary involvement. After thyroidectomy, neck dissection, ablative radioiodine therapy, and suppressive levothyroxine therapy, adjuvant therapy with isotretinoin (Accutane, Hoffmann-La Roche, Grenzach-Whylen, Switzerland), 60 mg/d, was started in July 1995 because of shortness of breath and exponentially increasing human thyroglobulin (hTg) levels. There were no severe side effects. The dyspnea disappeared 3 months after first administration. A cervical lymph node metastasis was removed in March 1996. Histologic examination showed a necrotic oxyphilic tumor with trabecular structure. The patient discontinued therapy with his medication twice, for 14 days in preparation for surgery and for 3 months starting in July 1996. While therapy was discontinued, hTg levels increased and dyspnea recurred. A least-squares model showed that hTg levels from July 1993 to May 1995 were different from those seen between July 1995 and May 1996, with a probability of more than 95% in a Mann-Whitney test (Figure 1 on page 246). Glucose hypermetabolism of the lung metastases assessed by F-18-FDG-PET (F-18-fluoro-deoxy-glucose available for position emission tomography) decreased (dose-uptake ratio, 6.1 ± 1.5 in October 1995 compared with 3.7 ± 1.3 in April 1996; P < 0.002). Computed tomography and chest radiography show unchanging diameters of the lung metastases. Isotretinoin therapy was started again in October 1996. As of February 1997, our patient is alive and well.
This case report provides evidence that isotretinoin inhibits growth and induces regression of metastases in oxyphilic thyroid carcinoma.
Anne R. Borner, MD
Dietmar Simon, MD
University Hospital Dusseldorf Dusseldorf, Germany
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
