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Optimal outcomes can only be achieved for patients with thyroid cancer through the utilization of a multidisciplinary team, suggests Gary L. Clayman, DMD, MD. Patients with advanced disease have likely been treated with surgery, systemic therapies, and are being followed using imaging, requiring the input from several specialists. Continued surveillance of patients should be conducted using diagnostic ultrasound, since cross-sectional imaging can occasionally miss certain findings, notes Clayman. This requires further multidisciplinary collaboration.
To emphasize the importance of multidisciplinary care, Marcia S. Brose, MD, PhD, shares a case study focused on the treatment of a patient with medullary thyroid cancer (MTC) using cabozantinib. In this situation, medical oncologist treated a patient who did not have measurable disease with cabozantinib, which resulted in the development of a fistula. The medical oncologists did not believe the fistula could have been predicted whereas a surgeon quickly recognized the risk, based on the location of the primary tumor, notes Brose.
In the third-line setting for patients with MTC, following treatment with vandetanib and cabozantinib, locoregional treatments, such as radiation or surgery, are the best options outside of a clinical trial, suggests Manisha H. Shah, MD. At this point, the best treatment in the third-line setting has not been established. In some instances, pazopanib or sorafenib could be suitable systemic therapies; however, a clinical trial is likely the best option, Shah notes.