Madrid, September 19, 2022 – New combinations of targeted therapies and immunotherapy are the future in the treatment of patients with advanced thyroid cancer. This new approach is based on evidence that immunotherapy is most effective when given in conjunction with drugs that slow tumor growth. Dr. Pilar Lopez Criado, head of the Lung, Head and Neck Tumors and Melanoma Section at MD Anderson Cancer Center Madrid, explains this in the context of World Thyroid Cancer Day, which is held on September 24.
“Targeted therapy achieves rapid responses but tends to run out in a year or two. Immunotherapy for its part ensures that the patient continues to enjoy the benefits of treatment. This combination is what we are working on in trials and what we did not have 5 years ago. It is not standard yet, but we are aiming for it to be applied in hospitals”, says the specialist. It is estimated that in 2022, 6,040 new cases of thyroid cancer will be detected in our country, with a ratio of 3:1 women/men1.
The combination of therapies and immunotherapy has shown advances, especially in the approach to advanced tumors resistant to radioactive iodine, which is the usual treatment in thyroid cancer, or where there are metastases. However, the scarcity of clinical trials on the disease means that new discoveries are limited. “A trial usually provides more adequate monitoring, much newer and more precise, better studies. So, what the trial contributes will have repercussions on the improvements we are going to see in the coming years”, argues Dr. Lopez. Among the latest advances is the fact that molecular diagnosis has been established as a method for detection of this type of cancer, which facilitates personalized treatment adapted to the needs of each patient.
Surgery, the cornerstone of thyroid cancer
Advances in the treatment of the disease have not altered the predominant role of surgery, whose techniques have also progressed. “Surgery is the cornerstone of thyroid cancer. A few years ago, a total thyroidectomy (removal of the thyroid gland) was performed in all cases. Now, there are other options in cases small tumors, like performing a hemithyroidectomy (removal of half of the thyroid) to avoid thyroid and parathyroid insufficiency”, explains Dr. Lopez Criado. The thyroid is also surgically removed in metastatic cases as it is the organ that absorbs iodine, and as such may prevent iodine from reaching affected areas of the rest of the body to neutralize tumor cells.
Dr. Lopez also highlights the role of the endocrinologist in the substitution of the thyroid gland after surgery. “Living without a thyroid is quite common since there are perfect substitute hormones. They just have to be adjusted. It is a question of managing the hormones which the endocrinologist can do very well. In fact, it is rare to find a patient suffering from problems with side effects of thyroid failure secondary to cancer,” she says. Thus, the work of the endocrinologist is essential to adjusting the patient's hormone levels and check that there are no relapses, local or systemic.
Warning signs of thyroid cancer
Although there is no specific symptom of the disease, the doctor recommends consulting any changes in the neck: a feeling of pressure, persistent discomfort, lumps or difficulties speaking or swallowing. Despite this, she explains that tumors in the thyroid gland can grow inward and may not be noticed externally.
“The benign form of the disease is the most predominant and is usually a goiter. But it may also be a sign of lung metastases or pleural effusion. In general, any symptom that persists for more than 10-15 days should be checked out with the family doctor”.
1.- Las cifras del cáncer en España 2022. Sociedad Española de Oncología Médica (SEOM): https://seom.org/images/LAS_CIFRAS_DEL_CANCER_EN_ESPANA_2022.pdf