Growing Options for RAI-Refractory Differentiated Thyroid Cancer - Episode 3
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Management of progressive thyroid cancer becomes perplexing when radioactive iodine (RAI), external beam radiation, and surgery are no longer effective and the decision to transition a patient to drug therapy is compromised by the side effects associated with these agents, state Michael Tuttle, MD, and Robert I. Haddad, MD. Previously, the next steps for treating progressive thyroid cancer were limited, but over the past 5 years, 2 targeted agents for RAI-refractory thyroid cancer were FDA-approved: sorafenib and lenvatinib.
While many endocrinologists are able to administer these agents, medical oncologists have the most experience and knowledge regarding their use and risks, states Haddad. Given the varying levels of knowledge inherent within each specialty, it is important to introduce a patient with thyroid cancer to a medical oncologist before they become RAI-refractory, Matthew H. Taylor, MD, believes. This strategy allows patients and oncologists to become acquainted, provides a team approach to decision making, and makes transitions in care seamless. While the oncologist is responsible for prescribing the targeted agents and conducting follow-ups, it remains beneficial for the endocrinologist to continue seeing the patient.
Clinical trials are currently assessing the role of adjuvant therapy in patients who have aggressive thyroid cancer but no metastatic disease, Haddad explains. Since clinical trials are more readily available to the medical oncology community, Haddad recommends that endocrinologists and head and neck surgeons communicate regularly with medical oncologists and refer patients earlier to assess eligibility for studies. Additionally, academic healthcare centers can provide more in-depth genomic profiling as part of screening for clinical trials of varied investigational therapies and treatment approaches.