Thwarting Thyroid Cancer

Only slightly larger than a quarter, the thyroid has immense responsibilities for such a small gland. Wrapped around the trachea, the thyroid regulates our metabolism, body weight, heart rate, blood pressure, and body temperature. 

Despite its key role in controlling the body’s systems, the thyroid falls out of regulation for many. More than 12% of the US population will develop a thyroid condition during their lifetime¹. One of these conditions is thyroid cancer, which affects nearly 44,000 people each year².  

There are two types of cells in the thyroid — follicular and parafollicular. These cells secrete hormones called thyroglobulin and calcitonin that are important biomarkers for thyroid cancer. When these biomarkers are elevated, the thyroid is likely behaving abnormally, and further tests should be run. Imaging can identify if the gland is swollen or reveal if there is a mass in one or both of its lobes. If a mass is identified, a special, minimally invasive biopsy called a fine needle aspiration (FNA) can determine whether cancer is present.

When thyroid cancer is detected, the recommended treatment is usually surgery³. When properly managed, nearly 90% of patients are declared cancer-free⁴. When other treatment is needed, however, radioactive iodine as well as hormone therapy, radiation, chemotherapy, and targeted therapy — as noted in this Private Health Management case study — can be considered.

To determine which approach to consider, it is important to understand what is happening inside the cancer cells. This is achieved by profiling the molecular characteristics of the cancer cells. While an FNA is less invasive than a regular needle biopsy, it yields a smaller number of cells, making detailed analysis of the molecular features of the cancer more challenging. However, thanks to the recent development of diagnostic tests that are optimized for the smaller amount of tissue typically available in thyroid samples, more than 100 genes associated with prognosis and treatment options can be easily examined to help identify possible treatment paths.

Progress understanding the molecular drivers in thyroid cancer have led to several new treatments in just the last few years⁵. For example, in 2021, the FDA approved the drug cabozantinib (Cabometyx®)^6,7 for advanced thyroid cancers where treatment with radioactive iodine was unsuccessful. Likewise, pralsetinib (Gavreto®)⁸ was FDA approved in 2020 for a particular subtype of thyroid cancer that has a mutation in a gene called RET.

This exciting progress in the fight against thyroid cancer has fueled the continued development of promising new therapies that will help us thwart thyroid cancers.

References

1. General Information/Press Room. American Thyroid Association https://www.thyroid.org/media-main/press-room/
2. National Cancer Institute. Cancer Stat Facts: Thyroid Cancer. SEER https://seer.cancer.gov/statfacts/html/thyro.html
3. National Comprehensive Cancer Network. NCCN Thyroid Cancer. NCCN https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=40 (2020).
4. Mazzaferri, E. L. & Massoll, N. Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin. Endocr. Relat. Cancer 9, 227–247 (2002).
5. Drug, Genomic Innovations Have Transformed Thyroid Cancer Treatment. Cancer Therapy Advisor https://www.cancertherapyadvisor.com/home/news/conference-coverage/american-society-of-clinical-oncology-asco/asco-2016/drug-genomic-innovations-have-transformed-thyroid-cancer-treatment/ (2016).
6. CABOMETYX® (cabozantinib) is a treatment option approved for certain patients with 2L differentiated thyroid cancer. Cabometyx HCP https://www.cabometyxhcp.com/dtc.
7. Research, C. for D. E. and. FDA approves cabozantinib for differentiated thyroid cancer. FDA (2021).
8. GAVRETO® (pralsetinib) for RET+ mNSCLC & Advanced Thyroid Cancer | HCP. gavreto https://www.gavreto-hcp.com/