Andrew G. Gianoukakis, MD: Over the last few years, it has been rewarding for those of us taking care of patients with thyroid cancer to offer something additional to patients who are radioactive iodine-refractory, no longer candidates for surgery, and are progressing. The approval of both sorafenib and lenvatinib have been game changers in that sense. However, while the drugs are efficacious, the [adverse] effects are important and often difficult to deal with, leading to dose decreases and ultimately to the drugs no longer working. Secondly, the drugs are multitargeted kinase inhibitors and hit many targets. That is what likely causes the widespread [adverse] effect profiles.
Today, we are developing more specifically targeted drugs with fewer [adverse] effects and equal efficacy. Consequently, the future is bright. Likewise, we are beginning to use these multitargeted kinase inhibitors in combination with other therapies. There is a clinical trial nearing completion combining lenvatinib with pembrolizumab, an immune checkpoint inhibitor.
Similarly, lenvatinib is being tried in the neoadjuvant setting prior to surgery in patients who are poor surgical candidates or nonsurgical candidates due to invasive disease in the neck. In the neoadjuvant setting, an attempt is made to use lenvatinib to shrink the tumor and allow for it to be resected. These are just some of the ongoing efforts we hope will lead to better care and more options for our patients with thyroid cancer. In addition to the newer agents, the more specific agents with fewer [adverse] effects and equal efficacy are either in development or have been recently approved.
Transcript edited for clarity.
Case: A 73-Year-Old Woman With Differentiated Thyroid Cancer
Clinical Work-up and Initial Treatment
Subsequent Treatment and Follow-up