Pioglitazone Therapy of PAX8-PPAR gamma Fusion Protein Thyroid Carcinoma

作者：Giordano Thomas J; Haugen Bryan R; Sherman Steven I; Shah Manisha H; Caoili Elaine M; Koenig Ronald J^*

来源：Journal of Clinical Endocrinology & Metabolism, 2018, 103(4): 1277-1281.

DOI：10.1210/jc.2017-02533

Context: A subset of thyroid carcinomas expresses an oncogenic paired box 8 (PAX8) and peroxisome proliferator activated receptor gamma (PPAR gamma) fusion protein (PPFP). The PPAR gamma/PPFP ligand pioglitazone is highly therapeutic in a transgenic mouse model of PPFP thyroid carcinoma, but whether pioglitazone is therapeutic in patients with PPFP thyroid carcinoma is unknown.
Case Description: Tumor blocks from 40 patients with progressive thyroid cancer despite standardof-care therapy were screened for PPFP, and the tumor from only one patient (2.5%) was positive. The patient had a 6.0-cm acetabular soft tissue metastasis from Hurthle cell carcinoma that caused severe pain on weight bearing and had a serum thyroglobulin level of 1974 ng/mL. After 24 weeks of therapy with pioglitazone, the metastatic lesion was 3.9 cm, the thyroglobulin level was 49.4 ng/mL, and the patient was pain-free. Thirteen months after discontinuation of pioglitazone, the metastatic lesion was 3.6 cm, the thyroglobulin level was 4.7 ng/mL, and the patient remained pain-free.
Conclusions: Pioglitazone may be therapeutic in patients with PPFP thyroid cancer. However, thyroid cancers that are progressive despite standard-of-care therapy appear to only rarely express PPFP.

• 出版日期2018-4