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PURPOSE: This article aims to comprehensively analyze the unique challenges in managing patients with metastatic Differentiated Thyroid Cancer (DTC) that develop radioiodine-refractory disease, especially in developing countries in Latin America. We discuss key contentious aspects of their treatment, such as the optimal timing for initiating systemic therapy, the choice of first-line medications, the appropriate timing for requesting molecular interrogation, and the challenges associated with accessing these drugs and molecular panels. METHODS: To illustrate these challenges and enhance understanding, we present five real clinical cases from the authors' experiences. RESULTS: Patients with Differentiated Thyroid Cancer (DTC) generally have an excellent prognosis, with an overall 10-year survival rate exceeding 97%. However, approximately 5% of DTC patients, especially those with distant metastases, may develop radioiodine-refractory disease, reducing survival rates. Access to medications remains difficult and time-consuming, particularly for patients within the public healthcare system. Urgent discussions on drug pricing involving all stakeholders are imperative. To break free from complacency, stakeholders must prioritize patient well-being by advocating for evidence-based drug pricing, increased participation in clinical trials, and streamlined regulatory processes. CONCLUSION: Beyond the recognized need for prospective randomized clinical trials to determine the optimal first-line drug and the timing of molecular testing, this type of manuscript plays a pivotal role in stimulating discussions and disseminating comprehensive knowledge about the challenges associated with treating and monitoring patients with radioiodine-refractory thyroid carcinoma, especially in developing countries.
RESUMEN
Eichhornia crassipes is one of the main weeds found in aquatic environments, being undesirable for many activities. The aim of this study was to evaluate the translocation of glyphosate and imazamox in E. crassipes. Eight intervals were studied for cutting leaves that received herbicides: 2, 4, 6, 8, 12 and 24 hours after application (HAA), and a treatment with no cutting (untreated). The glyphosate dose was 2,160 g a.e. ha-1 (commercial product - Rodeo) + 0.5% v v-1 Aterbane adhesive spreader and imazamox at 290.4 g i.a. ha-1 (commercial product - Clearcast). The treatments were installed in a completely randomized design with four replications. Glyphosate showed a bad control for all the periods of leaf cutting. The imazamox did not provide control within 12 HAA, while from 24 HAA onward the control was effective. There was not a great mobility of the glyphosate molecule in water hyacinth plants, a period above 24 hours being needed for a satisfactory translocation. For imazamox at least 24 hours were needed after herbicide application for the translocation to occur along with subsequent control.
Entre as diversas plantas daninhas encontradas em ambientes aquáticos, a Eichhornia crassipes é uma das principais, sendo espécie indesejável para muitas atividades. O objetivo deste trabalho foi avaliar a translocação de glyphosate e imazamox em plantas de E. crassipes. Foram estudados oito intervalos de tempo para o corte das folhas que receberam os herbicidas: 2, 4, 6, 8, 12 e 24 horas após a aplicação (HAA) dos produtos, além de um tratamento sem corte das plantas (testemunha). Utilizaram-se glyphosate na dose de 2.160 g e.a. ha-1 (produto comercial - Rodeo) + 0,5% v v-1 do espalhante adesivo aterbane e imazamox na dose de 290,4 g i.a. ha-1 (produto comercial - Clearcast). Os tratamentos foram instalados em um delineamento experimental inteiramente casualizado com quatro repetições. O glyphosate apresentou um controle insatisfatório quando realizado os cortes das folhas em todos os períodos avaliados. O herbicida imazamox não proporcionou controle em até 12 HAA, enquanto que a partir de 24 HAA do herbicida o controle foi eficiente. Não houve uma grande mobilidade da molécula de glyphosate nas plantas de aguapé, sendo necessário um período superior a 24 horas para uma translocação satisfatória. Já para o imazamox um tempo de mínimo de 24 horas após a aplicação do herbicida foi suficiente para que ocorresse a translocação e um posterior controle.