Authors' objectives
Vandetanib is a potent inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2), epidermal growth factor receptor (EGFR) and RET tyrosine kinases. Vandetanib inhibits VEGF stimulated endothelial cell migration, proliferation, survival and new blood vessel formation in in vitro models of angiogenesis. It is intended for use in patients with locally advanced or metastatic differentiated thyroid cancer that is refractory or unsuitable for radioiodine (RAI) therapy.
Thyroid cancer is the 20th most common cancer in the UK, accounting for less than 1% of all new cases. In 2011, the crude incidence rate of thyroid cancer was 2.5 per 100,000 population in males and 6.2 per 100,000 population in females in England. Distant metastases occur in less than 10% of patients with papillary and follicular carcinomas, but represent the most frequent cause of thyroid cancer related death. In 2013-14, there were 5,864 admissions for malignant neoplasm of thyroid gland in England, resulting in 15,444 bed-days and 6,133 finished consultant episodes. Three hundred and fifty-six deaths from thyroid cancer were registered in England and Wales during 2013.
The most common treatment for localised, differentiated thyroid cancer is partial or total thyroidectomy. This may be followed by RAI treatment or radiotherapy. In unresectable, recurrent and metastatic disease, treatment includes RAI (¹³¹I) therapy in patients with demonstrable RAI uptake and levothyroxine therapy to suppress secretion of thyroid-stimulating hormone. However, only a third of patients experience complete remission. Sorafenib, a tyrosine kinase inhibitor, is licensed to treat differentiated thyroid carcinomas that are refractory to RAI. Vandetanib is currently in a phase III clinical trial comparing its effect on progression free survival against placebo. This trial is expected to complete in May 2017.
Address for correspondence
NIHR Horizon Scanning Research&Intelligence Centre, University of Birmingham, Institute of Applied Health Research, Public Health building, Edgbaston, Birmingham B15 2TT
Tel: 0121 414 9077 Email: nihrhsc@contacts.bham.ac.uk
