Highlights from the 2017 3rd World Congress on Thyroid Cancer, with Ezra E. W. Cohen, MD, FRCPC, FASCO

August 22, 2017
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In today’s podcast, we’ll discuss some of the new research that was presented at the 3rd World Congress on Thyroid Cancer, held July 27th through 30th in Boston, Massachusetts. This podcast will be led by Cancer.Net Associate Editor, Dr. Ezra Cohen. 

Transcript: 

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ASCO: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.

You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

In today’s podcast, we’ll discuss some of the new research that was presented at the 3rd World Congress on Thyroid Cancer, held July 27th through 30th in Boston, Massachusetts. This podcast will be led by Cancer.Net Associate Editor, Dr. Ezra Cohen. Dr. Cohen is Associate Director of Translational Science at Moores Cancer Center at UC San Diego Health and leads the Solid Tumor Therapeutics research program there.

ASCO would like to thank Dr. Cohen for summarizing this research.

Dr. Cohen: Hi, I'm Dr. Ezra Cohen from University of California San Diego’s Moores Cancer Center. And today I'll be talking to you about the 3rd World Congress on Thyroid Cancer, which was held in Boston, Massachusetts, in late July 2017. This meeting brought together a truly international group of physicians and health care practitioners that were all interested in the treatment and management of patients with thyroid cancer. In terms of what was covered during the meeting, there were a few important and immediately relevant aspects of management of patients with this disease.

The first had to do with the initial diagnosis, where there can sometimes be some controversy or uncertainty with respect to whether a thyroid nodule actually is malignant or benign. As time has gone by and the analytics have improved, we now realize that genetic analysis of a fine needle aspirate from a thyroid nodule is incredibly accurate at predicting which thyroid nodules are cancer and which are indeed benign. And in fact, it has become routine care to use this type of genetic analysis when evaluating a thyroid nodule. Once a thyroid nodule is determined to be malignant, the next steps in management usually include surgery. It's now becoming fairly obvious that for small thyroid nodules, especially ones that are papillary thyroid in histology, and in young patients, that a partial thyroidectomy—that is removing only part of the gland—appears to be safe and carries with it much less long-term morbidity and now has become standard of care in many regions around the world.

Advancing from that to discuss patients with refractory or advanced disease, a number of different practice patterns and recommendations have emerged. In patients who have had surgery, who have had radioactive iodine, and unfortunately, whose disease continues to progress, we now have medical therapy that can help to control the disease. We actually have 4 drugs approved in thyroid cancer that have all been approved on the basis of randomized, large trials. Unfortunately, we are beginning to see that there are now patients who have had these agents, or at least 1 of these agents, and their disease continues to be refractory. Interestingly, some of the treatment recommendations that emerged during the meeting included sequencing agents of similar class but 1 after the other in an attempt to control the disease for a prolonged period of time. And now it's becoming fairly routine to go from 1 drug that works to another to another and eventually even a fourth with the idea that the next drug does have efficacy and can be effective at further controlling of the disease. Another strategy that was discussed at length included the addition of a second drug that had a different mechanism of action. For instance, whereas for differentiated thyroid cancer, drugs like sorafenib and lenvatinib are currently approved in the United States. The addition of a second class of drugs, such as everolimus or temsirolimus, seems to extend the benefit of these drugs and can even induce a response in patients who aren't initially responding.

Lastly, with respect to systemic therapy, it has also become quite clear that thyroid cancer carries specific mutations, and many of those mutations can be exploited by current therapeutic agents. One such mutation is in a gene called BRAF, B-R-A-F, and it's now clear that inhibitors of that gene function that are commercially available, although not approved for thyroid cancer, are effective in thyroid cancers that carry this mutation. Another example, although these drugs are not approved yet, are patients with thyroid cancer that carry fusions in a gene called NTRK, N-T-R-K. There are now NTRK inhibitors, that are in clinical trials, and clear reports of these agents working in thyroid cancer patients whose cancers carry these fusions.

And lastly, immunotherapy is beginning to have an impact, although quite early, in the management of patients with thyroid cancer. And clinical trials are underway, testing immunotherapy, especially in combination with already approved drugs in patients with differentiated thyroid cancer with very early data showing the potential for high activity combining these agents.

That's a summary of some of the discussion and findings at the 3rd World Congress of Thyroid Cancer held in 2017. Thank you very much for your attention.

ASCO: Thank you, Dr. Cohen. To find more information about thyroid cancer, visit www.cancer.net/thyroid.  And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.