PMC8024690_01
Treatment prior to anlotinib therapy. (A) Timeline of treatment prior to clinical study, including four operations in the neck, two sessions of RAI therapy and TSH suppression therapy with L-T4. (B) Functional iodine uptake was observed in the neck on the initial post-treatment whole-body scan. (C) No functional iodine uptake was observed in the neck on the second post-therapy whole-body scan, but an abnormal radioactive iodine uptake foci in anterior-inferior mediastinum. (D) Abnormal radioactive iodine uptake foci in anterior-inferior mediastinum was confirmed to be external contamination by change clothes. (E) Papillary thyroid carcinoma was confirmed pathologically with specimen from the 4th operation (HE stain, x200) after RAIR-DTC was developed, and Ki67 stain revealed about 10% positive rate. Tg, Thyroglobulin; TSH, Thyroid Stimulating Hormone; L-CND, Left-Central Neck Dissection; L-LND, Left-Lateral Neck Dissection; RAI, Radioactive Iodine.
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F1
Treatment prior to anlotinib clinical trial is summarized in the following figure (Figure 1).
Tumor shrinkage during placebo and anlotinib therapy. (A) Imaging evaluation on target and non-target lesions, including placebo therapy (baseline, C2, C8) and anlotinib therapy (baseline, C2, C8, C16, and C52). ((1): Tumor under the right subclavian; (2): Tumor in front of the right sternocleidomastoid muscle; (3): Tumor behind the left scapula; (4): Tumor in front of larynx and tumor in the cervical sheath; (5): Metastatic tumor of the left lung). Red Arrow: tumor. (B) Tumor shrinkage per review (Evaluation was performed before C12 in every two cycles and after C12 in every four cycles).
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F2
Progression occurred at C8 with placebo treatment (Figure 2A). So far, this patient has been treated with 52 cycles of anlotinib at the time of manuscript preparation, with a reduction of 93.79% in the target lesions, and no new lesions emerged (Figure 2A). Tumor shrinkage during placebo and anlotinib therapy are shown in figure below (Figure 2B).
TSH suppression therapy during anlotinib treatment. (A) Change of serum TT4 and FT4 during placebo and anlotinib therapy (Yellow dotted line: upper limit of FT4, Normal range: 12-22 pmol/L; Red dotted line: upper limit of TT4, Normal range: 66-181 nmol/L). (B) Change of serum TSH and Tg during placebo and anlotinib therapy (TSH normal range: 0.27-4.2 muIU/mL; Tg normal range: 3.5-77 ng/mL).
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F3
TSH suppression therapy with L-T4 was continued during anlotinib therapy (Figure 3).