A 67-Year-Old Woman With Differentiated Thyroid Cancer - Episode 5

RR-DTC: Phase 3 SELECT Trial

Lori Wirth, MD: In terms of patient selection on the SELECT trial, we saw patients with iodine-refractory DTC [differentiated thyroid cancer] of all different subtypes enrolled in the trial. Patients with papillary thyroid cancer, follicular thyroid cancer, Hürthle cell carcinoma, and also poorly differentiated thyroid cancer were all enrolled in the SELECT trial.

When we took a look at a subgroup analysis to see if all patients in the subgroups benefited, or only some of the patients in some of the subgroups, what we found was that there was good activity in all the subtypes of thyroid cancers enrolled. I think we’re seeing that lenvatinib has activity in all subtypes, not just papillary thyroid cancer but also follicular, Hürthle cell, and even poorly differentiated thyroid cancer.

One thing patients often ask me once they’re on lenvatinib and they’ve had a response is, “How long am I going to be on lenvatinib?” We now have data that can help answer that question. Andrew Gianoukakis did an analysis of the SELECT trial. What was found was that when patients do respond, the median duration of response is more than 30 months. That piece of data is very helpful in telling patients, in answering that really important question for patients.

Transcript edited for clarity.

Case: A 67-Year-Old Woman With Differentiated Thyroid Cancer

Initial presentation

  • A 67-year-old woman presents with a painless “lump on her neck”
  • PMH: unremarkable
  • PE: palpable, non-tender solitary right-of-the midline neck mass; otherwise unremarkable

Clinical workup

  • Labs: including TSH, anti-Tg antibodies WNL
  • Ultrasound of the neck revealed a 3.6 cm suspicious right mass arising from the right thyroid; 3 suspicious supraclavicular largest 2.0 cm in size
  • Ultrasound-guided FNAB of the thyroid mass and the largest lymph node confirmed papillary thyroid carcinoma
  • Patient underwent total thyroidectomy with central compartment and right selective neck dissection
  • Pathology: 3.6 cm papillary thyroid cancer arising in right lobe of thyroid, tall-cell features; extrathyroidal extension present; 2 of 6 positive central compartment lymph nodes, largest 1.6 cm, no extra nodal extension; 3 of 13 right lateral compartment involved nodes largest 2 cm, positive extra nodal extension
  • StageT2N1MX; ECOG PS 0

Treatment and Follow-Up

  • She was treated with radioactive iodine 150 millicuries
    • Whole body scan showed uptake in neck only consistent with thyroid remnant
  • Follow-up at 6 months TSH 0.1 mU/L; thyroglobulin 24 ng/mL
  • Chest CT scan showed 10 small bilateral lung nodules largest 1.1 cm
  • Follow-up CT neck and chest scan at 3 months was notable for a 1-2 mm growth in several lung nodules and 2 new distinct 8 mm lung nodules
  • Lenvatinib 24 mg PO qDay was initiated