Treatment of Advanced Medullary Thyroid Carcinoma with a Combination of Cyclophosphamide, Vincristine, and Dacarbazine: a Single-Center Experience

Experimental and Clinical Endocrinology & Diabetes, 07/11/2011

Although objective tumor response rates were low, the cyclophosphamide, vincristine, and dacarbazine (CVD) regimen allowed disease stabilization for a substantial period of time and had acceptable toxicity. After initial surgery, chemotherapy may therefore be considered as a medical treatment option.

Methods

  • 9 patients (5 males; age 55.0±4.0 years) with MTC were enrolled.
  • Prior to chemotherapy, progressive disease was established in all patients by use of WHO criteria.
  • On day 1 of each cycle, patients started with cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2, and dacarbazine 600 mg/m2; on day 2, patients received dacarbazine alone (600 mg/m2).
  • Treatment cycles were repeated at 21–day intervals and 6 cycles were planned for each patient.
  • The standard imaging procedure was computed tomography, and the primary end point was the objective tumor response rate.
  • After chemotherapy, patients were followed up until progression.

Results

  • 9 patients underwent a total of 57 cycles (mean 6.3±0.3 cycles).
  • Treatment responses were: 0% complete response, 11% partial response, 56% stable disease, and 33% progressive disease.
  • The median progression free survival was 13.6 months (range 5.8–24.2 months).
  • The median change (baseline vs. end of treatment) of calcitonin was –19% (range –70% to +174%).
  • Reversible myelosuppression and moderate gastrointestinal symptoms were the most common adverse events.

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