alexa Retrospective Study of Sirolimus and Cyclophosphamide in Patients with Advanced Differentiated Thyroid Cancers
ISSN: 2167-7948

Journal of Thyroid Disorders & Therapy
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Research Article

Retrospective Study of Sirolimus and Cyclophosphamide in Patients with Advanced Differentiated Thyroid Cancers

Poorni M Manohar1*, Lauren J Beesley2, Jeremy M G Taylor2, Elizabeth Hesseltine3, Megan R Haymart3, Nazanene H Esfandiari3, David A Hanauer4 and Francis P Worden5
1Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
2Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States
3Department of Endocrinology, University of Michigan, Ann Arbor, Michigan, United States
4Department of Computational Medicine and Bioformatics, University of Michigan, Ann Arbor, Michigan, United States
5Department of Oncology, University of Michigan, Ann Arbor, Michigan, United States
Corresponding Author : Manohar PM
Department of internal Medicine, University of Michigan, Ann Arbor, Michigan
Tel: 4404786330
E-mail: [email protected]
Received: June 20, 2015; Accepted: July 16, 2015; Published: July 17, 2015
Citation: Manohar MP, Beesley JL, Taylor GMJ, Hesseltine E, Haymart RM, et al. (2015) Retrospective Study of Sirolimus and Cyclophosphamide in Patients with Advanced Differentiated Thyroid Cancers. Thyroid Disorders Ther 4:188. doi:10.4172/2167-7948.1000188
Copyright: © 2015 Manohar PM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: We hypothesize that the combination of an mTOR inhibitor, sirolimus, with a well-known cytotoxic agent, cyclophosphamide, provides a well-tolerated and promising alternative treatment for advanced, differentiated thyroid cancers (DTC). Methods: This retrospective review extracted data from patients treated for advanced DTC at the University of Michigan Comprehensive Cancer Center from 1995 through 2013. Fifteen patients treated with combination sirolimus and cyclophosphamide were identified as the sirolimus+cyp group. Seventeen patients treated with standard of care and enrolled in clinical trials were identified as the comparison group. Results: The one-year progression free survival rate (PFS) was 0.45, 95% CI [0.26, 0.80] in the sirolimus+cyp population and 0.30, 95% CI [0.13, 0.67] in the comparison population. The hazard ratio for PFS from initiation of treatment was 1.47, 95% CI [0.57, and 3.78]. In patients treated as first line, one-year PFS rate was 0.57, 95% CI [0.30, 1.00] in the sirolimus+cyp group and relatively unchanged at 0.29, 95% CI [0.11, 0.74] in the comparison group. The hazard ratio for PFS for first line patients was 1.10, 95% CI [0.4, and 3.5]. In patients with 3 or fewer sites of metastases, the one year PFS was 0.58, 95% CI [0.33, 1.00] in the sirolimus+cyp group, and 0.37, 95% CI [0.17, 0.80] in the comparison group. The average number of toxicities was 0.87 in the sirolimus+cyp patients and 1.71 in the comparison group. Conclusions: The combination of sirolimus and cyclophosphamide was generally

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