An Era of Advances in Systemic Therapies for Advanced Thyroid Cancer
1Division of Hematology-Oncology, Moores Cancer Center at UC San Diego Health, La Jolla, CA.
Abstract:
Thyroid carcinomas comprise distinct pathologic subtypes. However, advancements in characterizing the molecular tumorigenesis of thyroid cancers have changed the treatment paradigm in the past decade. Genetic profiling has become an integral component of personalizing cancer care. Oral kinase inhibitors are currently standard-of-care therapies for progressive, radioactive iodine (RAI)-refractory differentiated thyroid carcinomas (DTCs) and medullary thyroid carcinomas (MTCs). Sorafenib, lenvatinib, and cabozantinib are multikinase inhibitors approved for patients with metastatic RAI-refractory DTC, whereas vandetanib and cabozantinib are approved for patients with MTC. Management of thyroid carcinomas has evolved such that targeted therapies have become therapeutic options for patients with BRAF, RET, NTRK, ALK, and ROS1 alterations and even have reported efficacy in anaplastic thyroid carcinomas. In this article, we review the advances made over the years in the treatment of metastatic thyroid carcinoma and focus on the systemic therapies that have recently transformed the treatment landscape of advanced disease.
Insights
Targeted therapies, including oral kinase inhibitors, are revolutionizing thyroid cancer treatment. These advancements offer new hope for patients with advanced or metastatic thyroid carcinomas, improving outcomes.
Area of Science:
- Oncology
- Molecular Biology
- Pharmacology
Background:
- Thyroid carcinomas have diverse subtypes, but molecular understanding has reshaped treatment.
- Targeted therapies are now crucial for managing progressive, radioactive iodine (RAI)-refractory differentiated thyroid carcinomas (DTCs) and medullary thyroid carcinomas (MTCs).
Purpose of the Study:
- To review recent advancements in metastatic thyroid carcinoma treatment.
- To focus on systemic therapies transforming the management of advanced thyroid cancer.
Main Methods:
- Review of current literature on thyroid cancer molecular tumorigenesis and targeted therapies.
- Analysis of approved oral kinase inhibitors and their efficacy in specific thyroid carcinoma subtypes.
Main Results:
- Oral kinase inhibitors like sorafenib, lenvatinib, cabozantinib, and vandetanib are standard care for metastatic RAI-refractory DTC and MTC.
- Targeted therapies show efficacy for mutations in BRAF, RET, NTRK, ALK, and ROS1, and even in anaplastic thyroid carcinomas.
Conclusions:
- Genetic profiling is integral to personalizing thyroid cancer care.
- Systemic therapies have significantly advanced the treatment landscape for metastatic and advanced thyroid carcinomas.
Related Concept Videos
01:27Tumor Immunotherapy
02:57Targeted Cancer Therapies
There are several types of targeted therapies against...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...