Chemotherapy of Thyroid Cancer with Adriamycin

Abstract

Thirty patients with advanced refractory metastatic thyroid carcinoma received chemotherapy with adriamycin at a starting dose of 45 to 75 mg per square meter intravenously every three weeks. Eleven patients demonstrated a greater than 50 per cent decrease in the size of their metastases. Subjective improvement, particularly relief of pain from bony metastases, was also observed. Histologic cell types responding included medullary (solid) (three of five), papillary-follicular (three of 10), Hürthle cell (two of five), spindle and giant cell (two of nine) and unclassified thyroid carcinoma (one of one). Although the rate of disease progression in the responding and nonresponding patients was similar before the start of adriamycin, the median survival from this point on was significantly superior (p<0.005) in the responders (median 11 + and range of over five to 40 + months, six of 11 living) to that of the nonresponders (median four and range of 0.1 to 23 + months, five of 19 living). Before the need to limit the total cumulative dose of adriamycin delivered to 550 mg per square meter was recognized, adriamycin-induced cardiomyopathy developed in three patients, but this side effect has not been observed since that limitation. Adriamycin appears to be a promising regimen for patients with progressive metastatic thyroid carcinoma. (N Engl J Med 290:193–197, 1974)