Nature reviews. Clinical oncology
-
The cost of monoclonal antibody therapies for cancer is soaring out of control. Healthcare payers and patients are increasingly struggling to meet the high costs, which can be up to US$100,000 a year. A number of methods have been proposed to control these costs-government price controls on cancer drugs, biosimilars and novel drug pricing strategies. This article discusses what the impact of these strategies would be in terms of their ability to reduce costs and their effect on innovative cancer drug discovery.
-
A 29-year-old woman was diagnosed with lymph-node-positive, steroid-hormone-receptor-negative and HER2/neu-positive breast cancer. She underwent surgery followed by cyclophosphamide, epirubicin, and 5-fluorouracil chemotherapy, and received radiotherapy followed by trastuzumab therapy for 1 year. During the tenth month of trastuzumab therapy, the patient reported a missed period and had a positive pregnancy test. ⋯ Cessation of trastuzumab and close monitoring of mother and fetus during pregnancy.
-
Review
Hypothyroidism related to tyrosine kinase inhibitors: an emerging toxic effect of targeted therapy.
Despite their inherent selectivity, targeted therapies such as tyrosine kinase inhibitors (TKIs) can cause unusual adverse effects. Sunitinib and sorafenib are multitargeted TKIs that have been demonstrated to induce hypothyroidism and thyroid dysfunction. Retrospective studies indicate that sunitinib can induce hypothyroidism in 53-85% of patients, and in prospective studies this complication has been reported in 36-71% of patients. ⋯ We propose a diagnostic and therapeutic algorithm for the management of TKI-related hypothyroidism. Prospective trials are needed to define the incidence of overt and subclinical hypothyroidism and thyroid dysfunction during therapy with sunitinib, sorafenib and potentially other TKIs. The safety and efficacy, and optimal dosing and timing of starting replacement therapy in patients affected by TKI-related hypothyroidism need accurate appraisal and should be evaluated prospectively in appropriately designed trials.