Dr. Kristen Otto from Moffitt Cancer Center discusses the common—and most effective—treatments for thyroid cancers, with surgery being the mainstay. Dr. Otto explains why choosing an experienced surgeon matters, how targeted therapies are playing a role in thyroid cancer care, and shares insight into where thyroid cancer care and treatment is headed.
Dr. Kristen Otto is a Head and Neck Endocrine Surgeon and an Associate Member in the Department of Head & Neck – Endocrine Oncology at Moffitt Cancer Center. Learn more about Dr. Otto.
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Transcript
Katherine Banwell:
Why is it important to seek care, even if it’s just for a second opinion, with a thyroid cancer specialist?
Dr. Kristen Otto:
Particularly on the surgical side, it has been proven that patients have better outcomes if they see a surgeon who is considered a high-volume thyroid surgeon. And that may be defined differently depending on what you read, but you generally want to see somebody who does at least 20 to 50 thyroid operations each year, rather than someone who does two or three each year. The cumulative expertise is obviously better if you see somebody who does it all the time.
And then access to some of the more state-of-the-art therapies such as biomarker or molecular testing, some of the fancy systemic therapy options, is also better for groups that are more subspecialty-focused, research-focused, and maybe tertiary care centers.
Katherine Banwell:
What are the types of therapies available for people with thyroid cancer?
Dr. Kristen Otto:
Surgery is generally the mainstay of treatment for most types of thyroid cancer, most stages of thyroid cancer. So, we generally try to see if there’s any way to get the patient safely through an operation to remove the thyroid and maybe remove any involved lymph nodes in the neck. So, surgery is mainstay. For patients who can’t have surgery, or for tumors who are sort of beyond the point of surgery, we do have alternative options.
So, targeted therapies are kind of the hot topic in thyroid cancer treatment these days. So, these are a class of drugs that we call tyrosine kinase inhibitors that have really evolved over the years.
They are like chemotherapy in a sense, but unlike chemotherapy, they’re administered orally rather than IV. And the more targeted the therapy, presumably the fewer sort of toxic effects the treatment has. So, the targeted therapies are sort of another option. Another thing we occasionally use for thyroid cancer, especially as an adjunct to surgery, is something called radioactive iodine. And that’s a pill form of radiation that can help to oblate remaining thyroid cells that could be left behind after surgery.
And then, we very rarely use other treatment strategies such as external beam radiation therapy, standard chemotherapy, quite, quite rare for thyroid cancer.
Katherine Banwell:
Dr. Otto, you’re at the forefront of research. What are the new and emerging therapies for people with thyroid cancer?
Dr. Kristen Otto:
Really, those targeted therapy options, and I say that as a very broad category of treatments.
So, the way this works is we have identified – the research world has identified various gene mutations that are responsible for the formation of thyroid cancers. They’re what we call the driver mutations. And the most common one that we all talk about that causes papillary thyroid cancer is something called the BRAF V600E mutation. There are now drug therapies that are specifically designed to target the BRAF mutation, so-called “anti-BRAF” drugs.
But we know that there’s actually additional mutations that various tumors have. So, other things that we see with papillary cancer, RET gene fusions, R-E-T gene fusions, we see. And there are anti-RET drugs. We see ALK gene fusions, and there are anti-ALK drugs. So, that’s really where this is going is, let’s understand all of the different molecular drivers for thyroid cancer, and then develop targeted therapies that can combat those particular mutations.
Katherine Banwell:
In recent years, cancer care has become much more personalized. How is treatment becoming tailored to the individual?
Dr. Kristen Otto:
It’s really that. It’s understanding the molecular drivers of the tumors, why they develop this tumor. Because not only does it tell us what they might respond to from a therapy perspective, but knowing those molecular drivers actually, in thyroid cancer, really helps us to understand, how is this tumor going to behave biologically over time?
What is, for instance, how likely is it going to be to spread to lymph nodes? How likely is it going to be to develop distant sites of spread? So, those are very important things to understand how these tumors will behave.