- 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.
- 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.