Eric Baudin

Radioiodine therapy for papillary and follicular thyroid carcinoma

Abstract. Radioiodine (131I) therapy is used in patients with papillary and follicular thyroid carcinoma for ablation of thyroid remnants and for treatment of persistent or recurrent disease. It should be used selectively, i.e. only in those patients for whom a clinical benefit may be expected.

Comparison of Two Mitotane Starting Dose Regimens in Patients With Advanced Adrenocortical Carcinoma

CONTEXTnMitotane is the only approved drug for treatment of adrenocortical carcinoma. Its pharmacokinetic properties are not fully elucidated and different dosing regimens have never been compared head to head.nnnOBJECTIVEnThe objective of the study was to investigate the relationship between mitotane dose and plasma concentration comparing two dosing regimens.nnnDESIGN/SETTINGnThis was a prospective, open-label, multicenter trial of a predefined duration of 12 weeks.nnnPATIENTS/INTERVENTIONSnForty mitotane-naïve patients with metastatic adrenocortical carcinoma were assigned to a predefined low- or high-dose regimen by the local investigator. Thirty-two patients could be evaluated in detail.nnnMAIN OUTCOME MEASUREnThe difference in median mitotane plasma levels between both treatment groups was measured.nnnRESULTSnDespite a difference in mean cumulative dose (440 ± 142 g vs 272 ± 121 g), median maximum plasma levels were not significantly different between the two groups [high dose 14.3 mg/L (range 6.3-29.7, n = 20) vs 11.3 mg/L (range 5.5-20.0, n = 12), P = .235]. Ten of 20 patients on the high-dose regimen reached plasma concentrations of 14 mg/L or greater after 46 days (range 18-81 d) compared with 4 of 12 patients on the low-dose regimen after 55 days (range 46-74 d, P = .286). All patients who reached 14 mg/L at 12 weeks displayed a level of 4.1 mg/L or greater on day 33 (100% sensitivity). There were no significant differences in frequency and severity of adverse events. Among patients not receiving concomitant chemotherapy mitotane exposure was higher in the high-dose group: 1013 ± 494 mg/L · d vs 555 ± 168 mg/L · d (P = .080).nnnCONCLUSIONSnThe high-dose starting regimen resulted in neither significantly different mitotane levels nor a different rate of adverse events, but concomitant chemotherapy influenced these results. Thus, for mitotane monotherapy the high-dose approach is favorable, whereas for combination therapy a lower dose seems reasonable.

Differential expression of galectin-3 in medullary thyroid carcinoma and C-cell hyperplasia

Objective and Design Galectin‐3 is a β‐galactoside‐binding protein that plays a role in cell adhesion and tumour progression. It was shown recently to diagnose malignant follicular thyroid lesions accurately. The reliability of this marker in the differential diagnosis between medullary thyroid carcinoma and C‐cell hyperplasia was studied by immunohistochemistry.