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Glitazone pretreatment boosted I-131 uptake

Issue: December 2011

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Annual Meeting of the ATA

INDIAN WELLS, Calif. — A short course of treatment with glitazone before radioiodine ablation may enhance cancer cells' uptake of I-131, researchers found.

Currently, adjuvant radioiodine therapy is physicians' only option for treating metastatic differentiated thyroid cancer, according to researchers at the University of Utah in Holladay, but the treatment becomes less effective after the initial round due to a de-differentiation of the cancer cells as the disease progresses. PPAR-gamma agents have demonstrated success in re-differentiating these cells and improving uptake of I-131, the researchers said, but studies are lacking.

For their study, the researchers sought to explore the potential of PPAR-gamma agents in this capacity through a retrospective chart review of 13 patients aged 29 to 61 years with metastatic thyroid cancer who were undergoing ablation with I-131. Of these, 11 had radiologically proven lung metastases while distant metastasis was suspected in the remaining patients.

Before initiation of I-131 therapy, the researchers administered 4-mg to 8-mg doses of rosiglitazone (Avandia, GlaxoSmithKline) to 10 patients and 30-mg doses of pioglitazone (Actos, Takeda) to three patients for 6 weeks. Results indicated a statistically significant reduction in mean thyroglobulin levels after treatment. Moreover, five patients who had minimal or no uptake of I-131 in the lungs after the initial round of radioiodine therapy experienced a considerable increase in uptake after treatment with glitazone. The researchers observed no side effects among the patients.

"In our series, 38% of patients receiving glitazone pretreatment enhanced I-131 uptake within lung metastases," the researchers wrote in an abstract. "We also noted a reduction in serum thyroglobulin levels in all subjects."

Further studies, however, are required to identify factors that may help select patients for pretreatment with glitazone and to gather more information about long-term efficacy and survival, the researchers concluded.

For more information:

• Wadwekar D. Poster 156. Presented at: the 81st Annual Meeting of the American Thyroid Association; Oct. 26-30, 2011; Indian Wells, Calif.

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