Maria Cabanillas, MD
Enrolling clinical trials can be a long process, especially in rare diseases with limited patient populations. This is a particularly significant issue for patients with anaplastic thyroid cancer, an extremely rare and aggressive disease, says Maria Cabanillas, MD.
“We need to work very hard to speed this up because these patients need effective therapies, and they need them now,” says Cabanillas, associate professor, department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center.
“We have a lot of patients that never even have the opportunity to come in and visit with an anaplastic thyroid cancer expert to determine if they should be enrolled on a clinical trial or be put on a targeted therapy outside of the trial, because the doctors at home tell them that there is no hope and they need to go to hospice. We need to change that.”
To make sure patients with anaplastic thyroid cancer receive effective therapy as quickly as possible Cabanillas and her colleagues initiated a program called Facilitating Anaplastic Thyroid Cancer Specialized Treatment (FAST). This program coordinates with administrative and clinical staff to ensure that patients with anaplastic thyroid cancer are identified and given rapid access to care. It has improved the average referral-to-disposition for patients with anaplastic thyroid cancer to half a day.
In addition to speeding up the process, new more effective treatments need to be explored, says Cabanillas. Immunotherapy has potential, but it presents a challenge because of the length of time it takes to have an effect. In an interview with OncLive
, Cabanillas discussed an upcoming clinical trial she is involved in that is combining immunotherapy with targeted therapy, that may offer a solution. She also discusses the challenges that still remain regarding the diagnosis of anaplastic thyroid cancer and what she sees on the horizon.
OncLive: What is the potential for immunotherapy in anaplastic thyroid cancer?
: I think immunotherapy in anaplastic thyroid cancer is going to be a challenge, but it is going to be a very good treatment for patients. The trick is to design trials that are going to be successful, knowing that anaplastic thyroid cancer is a very rapidly progressing, aggressive type of thyroid cancer and patients really need to get a response within weeks; they can’t wait months. Immunotherapy usually does take on average 3 or 4 months before it really starts to take effect. These patients don’t have that kind of time.
If we design the trials correctly, knowing this disease very well, we will be successful. Our idea in the study that we’ve designed and we’ve been funded for, is a trial using targeted therapy in conjunction with immunotherapy. The trial will start out by determining what the molecular mutations are in these patients’ tumors, and then they will be assigned a treatment cohort that will include immunotherapy plus the targeted therapy.
I think that is the way to go for 2 reasons. One, the targeted therapy buys you some time before the immunotherapy starts to work. That is really what these patients need. Two, we may actually be able to improve the efficacy of immunotherapy by using targeted therapy. This has been shown in a number of different malignancies, including in melanoma, where a BRAF and a MEK inhibitor were shown to improve the effect of the immunotherapy.
What is the status of this trial?
Right now this trial is written, it has been vetted by the sponsor, and we have a commitment of funding. We anticipate that we will probably start the trial sometime in early 2017. This trial will look at anaplastic thyroid cancer and poorly differentiated thyroid cancer, but its only at MD Anderson.