ELDERLY PATIENTS AND RAI-RESISTANT THYROID CANCER: WHERE DO WE STAND? F. Platini, L.D. Locati Vol.3 (2018), issue 3, pag. 30-32
Age is a strong prognostic factors for differentiated thyroid cancer (DTC). Incidence of DTC increases with age and older patients have a poor prognosis compared to younger subjects. In the future we expect an increase number of DTC patients in our clinic, due to the overdiagnosis of small tumor but also for the aging population. Older DTC patients tend to have more aggressive disease at diagnosis, such as less differentiated cancer, larger tumor volume and a higher probability to be radioactive iodine (RAI) resistant, requiring a more complex therapeutic approaches. Owing to co-morbidities, disabilities, polypharmacy and social issues, elderly patients require a pretreatment global evaluation to elucidate a personalized treatment pathway to avoid any risk of undertreatment. In this context, the upfront identi cation of “robust” and “frail” eldery patients could be helpful in this process. Recent data demonstrated that ef cacy of targeted therapies, lenvatinib in particular, is similar in elderly patients (> 65 years old) compared to younger with metastatic, RAI-resistant DTC. In contrast and, as expected, toxicities of any grade are more common in older patients, leading to more frequent drug reduction and discontinuation. This means that metastatic RAI-resistant DTC older patients can be potentially managed as younger but the identi cation of “frail” elderly is mandatory to avoid useless toxicity and morbidities. The identi cation of frailty in the elderly represents a poor prognostic factor for various oncologic population. Whether it could play a role also in DTC patients, it has to be demonstrated yet.