Experts discuss the 5-fold increase in thyroid cancer incidence, latest treatments

  • Pavankumar Kamat
  • Univadis Clinical Summaries
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  • In an interview with Medscape, Megan Haymart, MD, and Frank Worden, MD, from the University of Michigan in Ann Arbor, talk about the increasing incidence of thyroid cancer and current treatment options.

Key points

  • The incidence of low-risk thyroid cancer has increased substantially during the past few decades.
  • In South Korea, the incidence rose from 12.2 cases per 100,000 from 1993 to 1997 to 59.9 cases per 100,000 from 2003 to 2007.
  • The increase in incidence may be multifactorial, with overdiagnosis being the predominant driver.
  • Some thyroid cancers are relatively indolent, whereas others tend to behave aggressively. 
  • It is crucial to differentiate which thyroid nodules need evaluation and management and which nodules can be safely watched.
  • Selpercatinib (Retevmo) is the latest US-approved drug for the treatment of RET-altered thyroid cancers.
  • Pralsetinib (Gavreto) is in the approval process for advanced or metastatic RET-mutant medullary thyroid cancer and RET fusion-positive thyroid cancers. 
  • Evidence shows that pralsetinib is much better tolerated than pan-kinase inhibitors such as sorafenib and lenvatinib.
  • Although potentially actionable mutations in thyroid cancer are rare in number, therapies that target these mutations often are more tolerable than tyrosine kinase inhibitors. 
  • Among tyrosine kinase inhibitors, entrectinib and larotrectinib target neurotrophic tyrosine receptor kinase fusions.
  • Dabrafenib and vemurafenib have shown promise in radioactive iodine-refractory papillary thyroid cancers. 
  • The FDA has approved the combination of dabrafenib and trametinib. 
  • Currently, no agents show benefit for follicular thyroid cancers associated with RAS mutations.
  • Next-generation sequencing should be performed on all thyroid cancers to determine potentially actionable mutations.
  • There has been a major shift from the use of total thyroidectomy to the use of thyroid lobectomy ever since the American Thyroid Association's thyroid cancer guidelines were updated in 2015.