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Oncocytic, focally anaplastic, thyroid cancer responding to erlotinib

Department of Medicine, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA, thogan{at}hsc.wvu.edu

Jing Jie Yu, MD

Departments of Biochemistry, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA

H James Williams, MD

Department of Pathology, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA

Ramin Altaha, MD

Department of Medicine, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA

Xiaobing Liang, MD

Departments of Biochemistry, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA

Qi He, MD

Departments of Biochemistry, Robert C. Byrd Health Sciences Center & Mary Babb Randolph Cancer Center, West Virginia University, POB 9162 Morgantown, WV, 26506-9162 USA

Objective. To highlight the molecular findings and clinical response of a patient with rapidly progressing, focally anaplastic, oncocytic thyroid carcinoma (OTC) treated with erlotinib.

Case Summary. A 69-year-old woman with recurrent, focally anaplastic OTC was given a therapeutic trial of erlotinib, a small molecule inhibitor of epidermal growth factor receptor (EGFR). Formalin-fixed, paraffin-embedded portions of the tumor were analyzed for EGFR expression, and tumor genomic DNA was amplified by polymerase chain reaction (PCR) and subjected to EGFR mutation analysis.

Discussion. An early and dramatic response was achieved with erlotinib. The tumor was focally positive for EGFR by immunostaining and two point mutations were identified, one on exon 18 and one on exon 20 in the tyrosine kinase (TK) domain.

Conclusion. Erlotinib or other novel protein kinase pathway inhibitors should be evaluated further in patients with aggressive thyroid cancer variants, who may exhibit these and perhaps other tyrosine kinase mutations. J Oncol Pharm Practice (2009) 15: 111—117.

Key Words: anaplastic • EGFR • TKI • erlotinib • exons 18 & 20 • Hürthle cell • oncocytic • thyroid cancer

This version was published on June 1, 2009

Journal of Oncology Pharmacy Practice, Vol. 15, No. 2, 111-117 (2009)
DOI: 10.1177/1078155208101212


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