As far as immunotherapy is concerned, we have pembrolizumab (Keytruda), nivolumab (Opdivo), and many other PD-1 inhibitors. These have good activity, but many times they cause stable disease for a period of time. That is also another opportunity for combination therapies that have been successful in melanoma, lung cancer, and other tumor types. That should be coming to thyroid cancer, as well.
What advice do you have for oncologists who are treating patients with thyroid cancer?
It is important to start with the genes. A patient with thyroid cancer who is looking at first-line options and is resistant to radioactive-iodine therapy should have a somatic gene panel done to figure out the driver mutation. Even though lenvatinib and sorafenib are first-line agents that are approved in this indication, they do not depend on the gene. However, you will be needing that information if they have toxicities from these agents and need to switch.
These drugs are not FDA approved in thyroid cancer, but we can use them off-label with sufficient justification. The clinical trials are showing us good activity and a good safety profile. I would advise physicians to go ahead and get sequencing upfront.
What should community oncologists take away from this presentation?
The treatment paradigm of thyroid cancer continues to move forward. We have gotten out of the realm of cytotoxic chemotherapies that are now giving personalized treatments.
We also now have immunotherapies [in clinical trials]. We need to put more patients with thyroid cancer on clinical trials. I encourage patients and providers to think about that as they are looking at their options. We do have approved agents, but we need to do better and clinical trials are the way to improve.