Eradication of Papillary Thyroid Carcinoma In A Patient Receiving Pemetrexed and Bevacizumab

Abstract

ABSTRACT: Objective: To report a 66-year-old female patient whose medical management for advanced-stage, high-grade serous carcinoma of the ovary (HGSC-O) might have treated concomitant papillary thyroid carcinoma (PTC) diagnosed by fine-needle aspiration (FNA). Methods: Patient evaluation and management consisted of positron emission tomography (PET) scans, thyroid ultrasounds, FNA biopsies, and thyroid function tests. Results: The patient presented to the endocrinology clinic while undergoing treatment for HGSC-O with a PET scan revealing increased uptake in the thyroid gland. Due to the PET scan findings, she underwent a thyroid ultrasound examination which revealed co-existent multi-nodular goiter and a lesion with concerning features. FNA biopsy was read as PTC. Surgical intervention for PTC was delayed due to progression of the ovarian cancer. In the interim, she underwent chemotherapy with a regimen consisting of elesclomol, paclitaxel, pemetrexed (Alimta), carboplatin, gemcitabine (Gemazar), and bevacizumab (Avastin) at varying intervals. After the patient was able to complete near total thyroidectomy, surgical pathology revealed no viable malignancy. Conclusion: We postulate that the patient’s treatment for HGSC-O, namely pemetrexed (Alimta) and bevacizumab (Avastin), had antineoplastic effects against the PTC. These agents are not currently recommended treatment modalities for PTC. This hypothesis should be validated with further studies. Abbreviations: FNA fine-needle aspiration HGSC-O high-grade serous carcinoma of the ovary PET positron emission tomography PTC papillary thyroid carcinoma