Case 1: RAI-Refractory DTC


Andrew Gianoukakis, MD, reviews the case of a 71-year-old woman with RAI-refractory differentiated thyroid cancer and the panel discuss relevant clinical trial data.

Lori Wirth, MD: Thank you for joining us for this Targeted Oncology® Virtual Tumor Board®, which is focused on thyroid cancer. In today’s presentation, my colleagues and I will review 3 clinical cases. We will also discuss an individualized approach to treatment for each patient, and we’ll review key clinical trial data that impact our decisions. I am Lori Wirth from Massachusetts General Hospital in Boston, and today I’m joined by Dr Andrew Gianoukakis from the David Geffen School of Medicine in Los Angeles, California; and Dr Marcia Brose from the Jefferson University Sidney Kimmel Cancer Center, [in Philadelphia]. Thank you for joining us. Let’s get started with our first case. Andrew, take it away.

Andrew Gianoukakis, MD: Thank you, Lori. The first is a case of radioiodine-refractory differentiated thyroid cancer. The patient is a 71-year-old woman who presents with a painless lump on her neck and notes occasional swelling. Her past medical history is significant for hypertension, which is managed with medications, she has obesity with a BMI [body mass index] of 31, and osteoporosis. On physical examination, there is a palpable solitary nontender mass to the right of the midline, there is mild pain with movement, and restricted range of motion of the left hip. Otherwise, the physical exam is unremarkable. Laboratory evaluation disclosed a TSH [thyroid-stimulating hormone] of 1.1 µU/mL, and all other labs were unremarkable. An ultrasound of the neck was performed, which revealed a 3.0-cm suspicious mass in the right lobe of the thyroid, and 3 suspicious supraclavicular lymph nodes, with largest being 2.0 cm in size. An ultrasound guided FNA [fine needle aspiration] biopsy of the thyroid mass and the largest lymph node confirmed papillary thyroid carcinoma [PTC]. The patient underwent a total thyroidectomy with central compartment and right selective neck dissection. The pathology revealed a 3.0-cm papillary thyroid cancer and 4/14 lateral positive lymph nodes as well as 3/3 central lymph nodes that were positive for PTC, and it was probable stage III, T2N1 BMX. The ECOG score was 0.

This transcript has been edited for clarity.

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