Tag Archive for: thyroid cancer treatment
What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan?
What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan? from Patient Empowerment Network on Vimeo.
What questions should you ask about a proposed thyroid cancer treatment plan? Dr. Wirth provides guidance on self-advocacy, seeking a second opinion, and discussing essential molecular testing for identifying targetable gene alterations.
Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.
See More from Evolve Thyroid Cancer
Related Resources:
![]() |
![]() |
![]() |
Transcript:
Katherine:
What questions should patients ask about their proposed treatment plan?
Dr. Wirth:
So, Katherine your questions are so spot on, and these are the kinds of questions that we get asked in clinic all the time. And I could say one thing that I think, I don’t know if medical students still are in this, but I learned this in medical school. If a patient says to you, “What would you say to me if I were your mother?”
You’re not supposed to answer that question because of course you’re going to have your biases. But I realize people ask me that question all the time. And so, it’s a good question, so I should answer it because it’s a good question. But I think that I would simply encourage people to not be shy. Their doctors care deeply about them. Their doctors are pressed for time, but their doctors are always going to be happy to stop and answer every single question that the patient has. And the most basic questions are the best ones, but sometimes they’re also the hardest question to ask. But coming with a list of the important questions is very helpful. Bringing along a family member or friend and having them have their list of questions is also very helpful.
But writing down especially the hard questions can help you ask the question because it can be hard to say, “How long might this drug help me live?” Asking about how long I might live can be really hard to say, but if you’ve got it written down there, it’s a little bit easier to say. Or if it’s hard for you to get those words out, hand your doctor over your notebook, and your doctor can look at the questions and help answer the questions.
So, I just would encourage people to think in advance about what the questions are that they want to make sure that they cover and jot them down. And don’t be shy. Don’t be shy about saying, “Do you think it would be worthwhile for me to get a second opinion? And if so, who do you recommend?” And most doctors are perfectly content with somebody asking if they think a second opinion would be a good idea.
And I’ve always said if I were diagnosed with cancer, I would want to have a second opinion just to be sure that what my favorite doctor was saying to me really sounded right. So, don’t be shy about asking for second opinions. With thyroid cancer I also think now it’s so important that we’re doing the molecular diagnostics of the tumors for patients to identify those patients that have targetable gene alterations. And it is still a relatively new thing in oncology to do molecular diagnostics for thyroid cancer as well as other solid tumors. And so, it is something that is not always recommended or offered to patients. But that’s something that patients with thyroid cancer should absolutely ask their doctors about.
What Are the Benefits of Thyroid Cancer Clinical Trial Participation?
What Are the Benefits of Thyroid Cancer Clinical Trial Participation? from Patient Empowerment Network on Vimeo.
What are the benefits of thyroid cancer clinical trial participation? Dr. Lori Wirth discusses how clinical trials provide access to promising new treatments, offering patients additional options, and the potential for significant advancements in managing their disease.
Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.
See More from Evolve Thyroid Cancer
Related Resources:
![]() |
![]() What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan? |
![]() |
Transcript:
Katherine:
Dr. Wirth, what would you say to patients who are hesitant to participate in a clinical trial?
Dr. Wirth:
Oh, boy. So, that’s such an important question.
Katherine:
Yeah.
Dr. Wirth:
And I think that the natural reluctance to put oneself into an uncertain setting like a clinical trial is completely understandable.
But a couple of things that I would say is first of all there is a lot of really deep work that goes into identifying new agents that have promise in the preclinical setting from laboratories either within the pharmaceutical industry or within academics. The amount of smarts that goes into development new drugs as well as early testing to ensure safety and that there’s a real signal of activity, that amount of work that’s done before a clinical trial is launched is really quite significant. So, when we’re bringing a new drug into clinical trials, we already know that there’s a very good likelihood that that drug is going to have good activity.
Katherine:
Okay.
Dr. Wirth:
The other reason for patients to think about participating in clinical trials is when patients have metastatic disease in the solid tumor setting whether it’s colorectal cancer or breast cancer, unfortunately most of our treatments don’t work so well that there’s a chance of cure. However, if we can’t cure a cancer, the next best thing is to knock it back and hold it at bay for as long as possible so that people can feel well but also live as long as possible.
However, if we don’t have a drug that can work so well that can cure cancer completely many cancers ultimately are going to escape the control, and we’re going to need new therapies for those patients. When patients participate in a clinical trial that’s just giving them a whole other treatment option. And so, to have more options available gives more chances that there’s going to be a real homerun or a real success in terms of treatment.
So, I would much rather have my patient have three options of treatment rather than two options of treatment. And we can always turn to the drugs that we have that are already FDA approved as long as somebody’s well enough to receive cancer treatment. If there’s a promising clinical trial of a new agent that’s only available in a clinical trial, and if we use that earlier in the course of the disease, that gives us more options for down the road.
Understanding Targeted Thyroid Cancer Treatment Approaches
Understanding Targeted Thyroid Cancer Treatment Approaches from Patient Empowerment Network on Vimeo.
What are targeted thyroid cancer treatment approaches? Dr. Wirth explains standard options like multikinase inhibitors, newer gene-specific treatments, patient suitability for targeted therapies, and common side effects.
Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.
See More from Evolve Thyroid Cancer
Related Resources:
![]() |
![]() What Are the Benefits of Thyroid Cancer Clinical Trial Participation? |
![]() |
Transcript:
Katherine:
Thank you. Dr. Wirth, what are the targeted treatment approaches for treating thyroid cancer?
Dr. Wirth:
Yes, so we do have new options for treating iodine-refractory thyroid cancer, also anaplastic thyroid cancer, and then the medullary thyroid cancer.
So, the first group of drugs that were studied starting a decade ago and have become standard of care options for these patients are the multikinase inhibitors, which are targeted therapies. But the drugs target multiple kinases not just one kinase, so we call them multikinase inhibitors. Lenvatinib (Lenvima) is the multikinase inhibitor that’s used most often in iodine refractory thyroid cancer.
But we have other multikinase inhibitors as well. Cabozantinib (Cabometyx) is a drug that’s available now for second-line therapy in iodine refractory thyroid cancer. That’s a multikinase inhibitor. And then for medullary thyroid cancer multikinase inhibitors were studied about 10 years ago as well.
And cabozantinib (Cabometyx) and vandetanib (Caprelsa) are both multikinase inhibitors that have good activity and were FDA-approved for the treatments of medullary thyroid cancer. But one of the things that’s been so exciting in the last five to eight years is that we now know that a large portion of all of these various thyroid cancers are driven by specific gene mutations.
And many of those gene mutations lead to expression of abnormal proteins that make the cancer a cancer cell. And in many circumstances, those abnormal proteins driving the cancer cell growth are now targetable with gene-specific therapies. So, there’s been a lot of progress made recently in that area of the work that we do, which has really led to some great successes.
So, the first example of a really great success was in targeting the TRK protein, TRK. And that is aberrantly expressed in a subset of the iodine refractory differentiated thyroid cancers by virtue of a gene alteration called a fusion. So, you can see NTRK1 or NTRK 3 fusions driving a subset of iodine refractory differentiated thyroid cancer.
And there are now a couple of drugs that target TRK very potently and specifically including larotrectinib (Vitrakvi) that was studied in multiple different types of tumors all driven by NTRK fusions, including a fairly large cohort of patients with iodine refractory differentiated thyroid cancer. And in the thyroid cancer patients, we saw really high responses with larotrectinib, which is an oral drug taken by mouth at home every day.
And not only did we see very high response rates, but we also are seeing very durable responses where patients can remain on larotrectinib month after month after month or even for years with a significant regression of their thyroid cancer. Sometimes people even will have a complete response on larotrectinib. And they can tolerate larotrectinib well for the most part for a very long period of time. So, that’s a targeted therapy success story for patients with NTRK fusion-positive thyroid cancer. Another example is targeting RET fusions and RET mutations. So, we see RET fusions in iodine refractory differentiated thyroid cancer in a portion of them.
We also occasionally see RET fusions driving anaplastic thyroid cancer. And then more than half of patients with medullary thyroid cancers will have RET mutations. And so, the gene mutation is slightly different than a gene fusion, but the end result is very similar so that RET is overactive in these cancers and now is druggable with RET-specific inhibitors. The one that’s been studied the most in thyroid cancer is selpercatinib (Retevmo). And similar to larotrectinib and NTRK driven thyroid cancers serlpercatinib and RET-driven thyroid cancers has great activity, very high response rates, very durable responses. And again, it’s taken at home every day by mouth, and it’s really very well-tolerated overall.
Katherine:
Well which patients are a good fit for a targeted treatment approach?
Dr. Wirth:
So, the patients that are a good fit are patients first of all who need a systemic therapy.
So, for example, if a patient has had a thyroid nodule that’s not all that big, a biopsy shows it’s thyroid cancer, and the patient has a complete resection of that disease and may or may not have gotten treated with radioactive iodine.
But if they’re disease free they don’t need any further therapy. And a lot of patients are in that category which is the best-case scenario. But when patients have persistent disease that eventually is going to grow over time, then we do genotyping of the tumor or molecular diagnostics. It’s the same thing, different phrases. But then we’ll extract the DNA from the cancer cells to see what types of targetable gene alterations might be present driving that thyroid cancer. In patients who are found to have an NTRK fusion, a drug like larotrectinib is an option.
If we see a RET fusion, then a RET specific therapy might be an option. So, you need to have some disease that needs a systemic therapy, and then the target needs to be present as well.
Katherine:
What are the common side effects for a targeted approach?
Dr. Wirth:
So, the side effects are a little bit different flavor for the different drugs. So, larotrectinib, for example, is a potent and specific TRK inhibitor. And TRK is expressed in the development of the nervous system as well as the maintenance in full grown people of the nervous system. So, you can have on target TRK related side effects involving the nervous system from when patients are on larotrectinib.
So, we can, for example, see a little bit of dizziness or gait unsteadiness which is a direct result of inhibiting TRK. Or sometimes patients will develop kind of an unusual pain syndrome where when they’re getting close to the time that they’re supposed to take their next does of Larotrectinib when the amount of drug in the body is beginning to wane, then some patients will develop pain like joint pain for example, pain from arthritis but it seems to be exacerbated.
And then when they take their next dose of larotrectinib the pain goes away as well. So, there’s some impact on pain control that we can see as a side effect of larotrectinib. Fatigue I think is the other probably most common side effect which probably also is an on-target side effect from larotrectinib.
Katherine:
Yeah.
Dr. Wirth:
There can be some inflammation in the liver which we can see in blood tests, so we have to monitor blood tests for that kind of inflammation, which is uncommon but can be seen and sometimes will require some dose reductions in order to not have to worry about liver injury in a particular patient.
What Are Initial Thyroid Cancer Treatment Approaches?
What Are Initial Thyroid Cancer Treatment Approaches? from Patient Empowerment Network on Vimeo.
What are initial thyroid cancer treatment approaches? Dr. Lori Wirth explains why surgery is the primary treatment, when radioactive iodine is appropriate, and the need for lifelong thyroid hormone replacement after thyroidectomy.
Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.
See More from Evolve Thyroid Cancer
Related Resources:
![]() |
![]() What Are the Benefits of Thyroid Cancer Clinical Trial Participation? |
![]() What Questions Should You Ask About a Proposed Thyroid Cancer Treatment Plan? |
Transcript:
Katherine:
So, what are the main treatment classes for each type?
Dr. Wirth:
So, surgery is always considered a mainstay for any type of thyroid cancer whenever possible. Often patients will present with a lump in their neck that is noticed either by themselves or on physical examination and is noticeable before the cancer has spread to other parts of the body. And that’s definitely the best-case scenario. If those cancers can be completely resected by surgery with either a hemithyroidectomy or a total thyroidectomy, then there’s a reasonably good chance of cure in many cases.
So, surgery is first and foremost the treatment that we think about. Then for the subtypes of thyroid cancer that arise from the regular thyroid cells namely papillary thyroid cancer, follicular thyroid cancer, oncocytic, and high grade.
Those patients will often also be treated after surgery with radioactive iodine.
The normal thyroid tissue takes up iodine from the blood in order to make thyroid hormone. And we can make iodine radioactive, give that to a patient, and it can sometimes be taken up by the thyroid cancer cells just like normal thyroid cells would take up normal iodine from the blood. And if those cells take up radioactive iodine, then they’re killed off by the radioactive iodine. We know, however, that anaplastic thyroid cancers don’t take up radioactive iodine.
So, we don’t use radioactive iodine ever in anaplastic thyroid cancers. And then also in medullary thyroid cancers, because they’re really a completely different cell altogether, those cancers are not treated with radioactive iodine as well.
Katherine:
Okay.
Dr. Wirth:
So, most patients will need to have surgery. Many patients will also be treated with radioactive iodine. And for many, many patients with thyroid cancer, that’s all the treatment that they need, and they’re done.
There are, however, patients who will have more aggressive thyroid cancer or thyroid cancer that’s already metastasized to other parts of the body. And if those cancers don’t respond to radioactive iodine, then we consider them radioactive iodine resistant or refractory. And then we have other treatments in the arsenal for those cases.
Katherine:
This may seem like a very simple question to you. But once the thyroid has been removed, doesn’t the patient then have to take some sort of supplement for the rest of their lives?
Dr. Wirth:
Yes, exactly. So, the job of the thyroid gland mostly is to make thyroid hormone. And thyroid hormone is one of the things that governs the body’s metabolism. So, if you take away the thyroid gland, then without the thyroid hormone replacement patients will become hypothyroid. And eventually it can be so severe that people can be quite, quite, quite ill. So, anyone who’s had a complete thyroidectomy will need treatment with thyroid hormone replacement for the rest of their lives.
Emerging Advancements in Thyroid Cancer Treatment
Emerging Advancements in Thyroid Cancer Treatment from Patient Empowerment Network on Vimeo.
What are the latest thyroid cancer treatment advancements? Expert Dr. Megan Haymart from the University of Michigan shares an overview of treatment updates along with proactive advice about actionable mutations for personalized thyroid cancer treatment.
[ACT]IVATION TIP
“…if you have high-risk advanced disease that’s progressing, I think it’s very important to ask your physician if they’ve done tumor sequencing to see if there’s any actionable mutations, because then you could have more targeted treatment.”
See More from [ACT]IVATED Thyroid Cancer
Related Resources:
![]() |
![]() Advancing Thyroid Cancer Care: Tailored Treatment and Patient Involvement |
![]() Personalized Treatment Approaches in Advanced Thyroid Cancer Management |
Transcript:
Lisa Hatfield:
Dr. Haymart, new advancements in thyroid cancer treatment are emerging. What are some promising therapies on the horizon, and how might they benefit patients?
Dr. Megan Haymart:
So there’s a couple of exciting new treatment options that are available. So one is for high-risk patients who have advanced disease. So this will be a minority of all the patients I see. So it’s probably five to 10 percent that have high-risk advanced disease that’s progressing at most, probably closer to 5 percent. For these individuals, we now have targeted treatments where we can do molecular testing of the tumor, and try to identify the mutations and then give treatments that are targeted towards those mutations.
Not everybody needs this. So many of my patients do great with sort of the standard therapy of surgery, maybe surgery and radioactive iodine if they have papillary or follicular thyroid cancer, they had some lymph nodes involved, but there are some where they have distant metastasis, it’s aggressive, it appears to be growing. And so we do have new treatment options and there’s more and more trials and treatment options becoming available every day.
The other exciting thing that’s available now is there’s new treatment options for lymph node metastasis. So most of the time for lymph node metastasis, you’re going to have another surgery. You always want to see the surgeon first, but sometimes there’s patients who’ve had multiple neck surgeries. The surgeon can’t go back in, or it feels like it’s too high risk to go back in.
We now sometimes use percutaneous ethanol ablation. We’re starting to use radio frequency ablation to treat these isolated lymph node mets when surgery is no longer an option. And so I think that it’s exciting because we have opportunities for patients that we didn’t have in the past. And I think it’s just going to continue to improve in regards to use of these new therapies.
Lisa Hatfield:
Okay, thank you. And do you have any activation tips for that question?
Dr. Megan Haymart:
My activation tip for this question is specific to individuals with high-risk advanced disease that’s progressing, And so if you have high-risk advanced disease that’s progressing, I think it’s very important to ask your physician if they’ve done tumor sequencing to see if there’s any actionable mutations, because then you could have more targeted treatment. Some of these targeted treatments work better, some of them have lower side effects, and so it’s really an era of more tailored care, and this is an important question to ask.
Lisa Hatfield:
Dr. Haymart, how do genetic mutations and molecular markers influence treatment decisions in thyroid cancer and what personalized medicine approaches are being developed?
Dr. Megan Haymart:
So for patients with advanced disease, and it’s progressing, so they have distant metastasis, it’s growing. We can now test for mutations in the tumor to see if there’s any actionable mutations that patients can get targeted treatment. And so that wasn’t available in the past and it is now. And I think it’s really changed the way we take care of our advanced thyroid cancer patients. And my activation tip for this question is, if you have advanced progressing thyroid cancer, ask your doctor if your tumor has had sequencing to see if there’s an actionable mutation because there may be a targeted treatment that you’re a candidate for.
Understanding Thyroid Cancer Treatment Options and Follow-Up Care
Understanding Thyroid Cancer Treatment Options and Follow-Up Care from Patient Empowerment Network on Vimeo.
What’s key for thyroid cancer patients to know about treatment options and follow-up care? Expert Dr. Megan Haymart from the University of Michigan shares her expert knowledge about various treatment paths and proactive patient advice to ensure optimal care.
[ACT]IVATION TIP
“…it would be important to ask how many surgeries have you done in the past year? Typically high volume is considered more than 25, very high volume, some of the physicians, some of the surgeons will do 100 a year. So that’s very important to ask this and ask them what is their complication rate? What are the complications that we might see?”
See More from [ACT]IVATED Thyroid Cancer
Related Resources:
![]() Thyroid Cancer Explained: Types, Staging, and Patient Communication |
![]() |
![]() |
Transcript:
Lisa Hatfield:
Dr. Haymart, can you explain the typical treatment journey for someone newly diagnosed with thyroid cancer and what can patients expect in terms of surgery, radioactive iodine therapy, and follow-up care?
Dr. Megan Haymart:
So patients typically have a biopsy and that’s how they find out they have thyroid cancer. Afterwards, they’re most often referred to surgery and so when they meet with the surgeon, the surgeon might talk about one, not doing the surgery, so just following it. But we don’t do that as often, but sometimes with small cancers and depending on what else is going on in a patient’s life at the time. Two, they might offer lobectomy. So the thyroid is a butterfly-shaped gland in the neck. So they might talk about taking out half the thyroid, not the whole thyroid. Or they’ll talk about a total thyroidectomy, taking out the whole thyroid. They should talk about the risk and benefits of both of those.
After the surgical pathology is back if someone had a total thyroidectomy for papillary or follicular thyroid cancer, radioactive iodine is a treatment option. And again, it’s not recommended for everybody, but for some patients, the things within the pathology look higher risk. There might be lymph nodes involved or signs of invasion. Radioactive iodine is a treatment option.
And then long-term, most patients are followed with neck ultrasounds, with laboratory work. Sometimes if there’s more suspicion, they may have additional, a suspicion of recurrence, they may have additional imaging, but for the most part, it requires lab work and periodic neck ultrasound during follow-up.
And so when patients are sort of along this pathway, I think a couple of things are important to know. One, sometimes it doesn’t move super fast. So it’s pretty typical, like between diagnosis and meeting with the surgeon, it might be a month, and then surgery might be a month or so after that. Radioactive iodine might be a couple months after that. And so that first six months to a year can be very stressful for a patient. So I think that’s important to know.
And then two, I think it’s important to make sure that when you go along this process, you have physicians that you trust and that you can rely upon. So you can still talk with your PCP who you know quite well. You may now have an endocrinologist that you see, and this might be new for you. You may have a surgeon that you see, and this might be new for you. And so you want to ask them the questions that you have.
And my activation tip would be that you want to make sure that you have high volume and experienced specialists. So, for example for surgery, it would be important to ask how many surgeries have you done in the past year? Typically high volume is considered more than 25, very high volume, some of the physicians, some of the surgeons will do 100 a year. So that’s very important to ask this and ask them what is their complication rate? What are the complications that we might see?
And then similarly for the endocrinologist, you want to ask what proportion of your patient population are thyroid cancer patients? How comfortable are you following thyroid cancer patients long-term? And you may get varying answers. And so I think it’s important just to ask these questions so that you feel comfortable that you have experienced providers taking care of you.