http://www.onclive.com/conference-coverage/ata-2014/ATA-Highlights-New-Thyroid-Cancer-Research
The impact of radioactive iodine (RAI) on long-term outcomes, potential
combination strategies, molecular profiling, and novel therapeutics for
patients with thyroid cancer were among some of the topics highlighted
at the 2014 American Thyroid Association (ATA) Annual Meeting.
The five-day conference, held in Coronado California from October 29 to
November 2, 2014, is geared toward endocrinologists, internists,
surgeons, nuclear medicine scientists, pathologists, and other
healthcare professionals. Presentations at the meeting encompass a wide
array of topics in thyroidology, including the treatment of various
neoplasms.
One of the more exciting studies presented at the meeting, from
researchers at the Massachusetts General Hospital, demonstrated the
feasibility of
BRAFV600E mutation detection using a blood-based assay in patients with papillary thyroid cancer (PTC). In general,
BRAF
mutations are associated with a worse overall prognosis, resistance to
RAI therapy, and an increased risk of metastases and mortality. Results
from the analysis suggest that a blood-based assay could be used for
diagnosis, postoperative surveillance, and to monitor treatment response
to BRAF inhibitors.
Adding to the importance of
BRAF in PTC, researchers from the
Beth Israel Deaconess Medical Center found lower levels of large
non-coding RNA (LincRNA) neighboring the thyroid peroxidase gene in
patients with BRAFV600E-positive PTC. These findings suggest that
LincRNA could be involved in the regulation of iodine metabolism
associated gene expression, suggesting LincRNA could be used for
monitoring patients undergoing treatment.
"The identification of new circulating markers, if validated, should
improve both the diagnosis and longitudinal follow-up of patients with
papillary thyroid cancer," Robert C. Smallridge, MD, president elect of
the ATA, said in a statement.
Differentiated Thyroid Cancer
For patients with differentiated thyroid cancer (DTC), RAI therapy has
been utilized as a standard therapy for more than half a decade. An
examination of nearly 5000 patients from 1987 to 2012 revealed that
thyroidectomy followed by RAI therapy correlated with a survival benefit
in patients with high risk DTC. However, this analysis did not find the
same benefit in patients with low risk disease, suggesting an optimal
setting for RAI use.
Further insight was added through an examination of thyroid hormone
suppression therapy (THST) administration over the same timeframe.
Overall, moderate but not aggressive THST was associated with improved
survival in all DTC stages. Furthermore, the use moderate THSH was
predictive of improved disease-free survival following surgery.
"Their findings are important—that these patients don't need to be
aggressively suppressed to an undetectable level of TSH, but rather
somewhere in what they defined as a moderate hormone level," Naifa L.
Busaidy, MD, associate professor at MD Anderson Cancer Center, said in
an interview with
OncLive. "It’s an interesting study with
important findings that a lot of us had a gut feeling about but didn't
have the data to back it up. Now we have several thousand patients' data
showing that this might be important."
To build on treatment with RAI, researchers looked at the therapy in
combination with lithium for patients with metastatic DTC who did not
respond to initial RAI therapy. In this study, patients received oral
lithium for 7 days, which started 5 days before RAI therapy. With the
combination approach, 45% of patients had stable disease at 6 months,
resulting in a significant improvement in progression-free survival.
After 10 years of follow up, patients in the combination arm showed
slightly higher survival rates than with RAI alone (67.9% vs 66.8%). The
median survival with the combination was 126.2 versus 105.4 months,
after propensity score matching.
Medullary Thyroid Cancer
Medullary thyroid cancer (MTC) is generally treated with surgery
followed by adjuvant therapy. In the past few years, two novel therapies
have gained approval as treatments for patients with this rare cancer.
“The biggest challenge we're having now in the field of medullary
thyroid cancer, certainly as researchers, is that we don't have a third
line, and there are patients now who are getting to that third line.
And, unfortunately, now that is a big question mark," Ezra Cohen, MD,
professor of medicine, UC San Diego Moores Cancer Center, said in an
interview with
OncLive.
To attempt to address this, a study explored a unimolecular micelles
conjugated with the somatostatin analog KE108 as a delivery mechanism
for the HDAC inhibitor AB3. In a culture, the targeted delivery of the
nanocarrier was associated with increased uptake by MTC cells. These
early findings suggest the possibility for better therapeutic outcomes
with less systemic toxicity.
"This study shows that it is not just the
intensity or duration of exercising that is important but also the
timing of when it occurs," said Jill Kanaley, professor in the MU
Department of Nutrition and Exercise Physiology. "Results from this
study show that resistance exercise has its most powerful effect on
reducing glucose and 
