65: Thyroid Cancer Does Not Respond to RAI⎢Treatment Options

Ezra Cohen, MD, is a board-certified oncologist and cancer researcher. He cares for patients with all types of head and neck cancers, including esophageal, thyroid and salivary gland cancers.

Dr. Cohen is also an internationally recognized expert on novel cancer therapies and heads the Solid Tumor Therapeutics program at Moores Cancer Center. Much of his work has focused on squamous cell carcinomas and cancers of the thyroid, salivary gland, and HPV-related oropharyngeal cancers. As a physician-scientist, he is especially interested in developing novel therapies and understanding mechanisms of sensitivity or resistance; cancer screening; and using medication and other agents to delay or prevent cancer (chemoprevention). He was recently appointed chair of the National Cancer Institute Head and Neck Cancer Steering Committee, which oversees NCI-funded clinical research in this disease.

Dr. Cohen is editor-in-chief of Oral Oncology, the most respected specialty journal in head and neck cancer. A frequent speaker at national and international meetings, he has authored more than 120 peer-reviewed papers and has been the principal investigator of multiple clinical trials of new drugs in all phases of development.

In this episode, topics include:

• Drug therapy for patients that fail standard therapy; including surgery and RAI
• Not all patients have same behavior for their cancer
• Some cancers are aggressive
• Not many thyroid cancer patients are affected by this; maybe a few thousand in the U.S., but not tens of thousands
• What is the treatment protocol for therapy?
• Lenvatinib or Sorafenib is the treatment for refectory thyroid cancer
• Lenvatinib tends to be more effective
• Sorafenib is tolerated by the patient better
• Other options to consider include, molecular profiling or some thyroid cancers carry mutation that is targetable, or BRAF
• BRAF inhibitors used with thyroid cancer patients
• Molecular profiling
• DNA sequencing
• Side effects include, what patient will feel and those that appear in blood tests
• Side effects include fatigue in 60% patients, hand or foot blisters, nausea and vomiting
• Side effects in blood tests include high blood pressure, increase in liver enzymes, and a reduction in blood counts
• VEGF receptor
• CT scans and ultra sounds or thyroglobulin as an indicator that thyroid cancer not responsive to traditional therapy
• We don't want to make the patient feel worse; the question is when to treat the patient with drug therapy
• Drug treatment does no cure the disease
• Holidays from the drug and be rid of side effects
• When restarting drug, disease responds again
• Pediatric care
• Immunotherapy

NOTES

Ezra Cohen, MD

American Thyroid Association