Friday, November 25, 2022

Treatment For Thyroid Cancer That Has Spread To Lungs

A Promising Option For Cancers With Ret Alterations

Metastatic Lung Cancer | Dr. Nidhi Tandon

Its not just that we have a new drug to help treat our patients with RET-altered thyroid cancers, but the drug has really good activity and a good side-effect profile compared with other FDA-approved treatments for thyroid cancer, Dr. Wirth said.

Also important, Dr. del Rivero said, is that selpercatinib shrank thyroid tumors containing a the RET V804 mutation, which are resistant to other therapies.

Its still not known if selpercatinib will help patients live longer, she continued. But she said the results so far suggest that the drug will eventually become the first-line treatment for people with RET-altered cancers, especially medullary thyroid cancer.

More information is needed, but we are optimistic about this treatment, Dr. del Rivero added.

To help provide this additional information, Eli Lilly has launched a phase 3 clinical trial that will compare selpercatinib with either cabozantinib or vandetanib in people with advanced, RET-mutated medullary thyroid cancer. However, Dr. Wirth said, the COVID-19 pandemic has temporarily slowed or halted enrollment of patients into the trial at some study sites, including her hospital.

Finally, Dr. Wirth said, Now that we have a really good RET-specific therapy, we need to make sure that doctors and patients know that its important to do genomic testing on tumor samples from patients with medullary thyroid cancer, to find out if they contain alterations in RET.

Changes In Serum Tgab Levels

According to the serum TgAb grouping method used in the present study, the TgAb level was < 1,000 IU/mL in 27 patients, 1,0004,000 IU/mL in 13 patients, and > 4,000 IU/mL in 7 patients. The changes in the serum TgAb levels are shown in Figure 2.

Figure 2. Changes in serum TgAb levels from the initial 131I treatment to the end of follow-up in 41 of the 47 patients with persistently negative Tg and elevated TgAb levels. Six patients were excluded from this figure because their TgAb levels were consistently higher than 4,000 IU/mL during 131I treatment and follow-up.

In the < 1,000 IU/mL group, the serum TgAb level decreased in 25.53% of patients with an average change of 373 to 94.5 IU/mL from the diagnosis of pulmonary metastases to the end of follow-up. The Tg level increased in the remaining 31.91% of patients with an average change of 493.6 to 917.7 IU/mL.

In the 1,0004,000 IU/mL group, a decrease in the serum TgAb level was seen in seven patients and an increase was seen in six . In the seven patients with a decreased TgAb level, the average TgAb level decreased from 2,021 to 766 IU/mL. In the six patients with an increased TgAb level, the mean TgAb level was 1687.5 IU/mL before 131I treatment at the end of follow-up, five patients’ TgAb level had increased to 4,000 IU/mL, and one patient’s TgAb level had increased from 1,008 to 1,048 IU/mL.

Just Found Out My Thyroid Cancer Has Spread Into My Lungs

  • Hi Lolabean,

    Thank you very much for your reply. I just can’t really help but worry :(.. I still want to see my son grow up so I am very worried about it. Now I will just have to wait for the result of my CT scan. I hope you were right that it is just fathom pains..but I will keep my eye on it and see the GP if it persists.

    I am so happy that I found this site and can actually communicate to people who could relate to me.

    Thank you very much for your time.

    Take care, how are you by the way, are you all clear?

    Later,

  • in reply to FormerMember

    Hi Lois

    Its natural to worry, when I was having my RAI scan I heard them say something mets but missed out on the 1st part so was freaking out it was in my lungs. Turns out not to be, but just in the neck area, they were saying no lung mets. I think they expected it to have been there with the spread in neck.

    I am just waiting on my follow up scans in Jan to see if its gone, but I am worried about it now, there was lots of up take on the left area of the thyroid :

  • Hi Lolabean,

    Yeah, we will get rid of this, no matter how long it will take and we will bring them down!! lol!

    Thank you Lolabean for your time, I really appreciate it. I feel like a heavy baggage has been lifted off my shoulder.

    Goodluck with your check up tomorrow 🙂 and hopefully you find Mr. Right soon :).

    Take care.

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    Surgical Resection Offers Long

    Idit Tessler1,2 MD, MPH, Oded Cohen1,2 MD, Judith Diment2,3 MD, Yonatan Lahav1,2 MD, Doron Halperin1,2 MD, MPH and Taiba Zornitzki2,4 MD

    1Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel

    2Hadassah School of Medicine, Hebrew University, Jerusalem, Israel

    3Department of Pathology, Kaplan Medical Center, Rehovot, Israel

    4Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Rehovot, Israel

    What Should I Do If I Have Symptoms Of Metastatic Thyroid Cancer

    Radiation Treatment For Thyroid Cancer

    As with other types of cancer, thyroid cancer that is detected in its early stages is more easily treatable and more likely to lead to a positive outcome and quality of life. If you are experiencing any symptoms associated with thyroid cancer, it is important to consult a physician as soon as possible to receive an accurate diagnosis and treatment plan.

    Moffitt Cancer Center offers comprehensive diagnostic, treatment and supportive care services for individuals with thyroid cancer. Whether you have been diagnosed with thyroid cancer or are experiencing metastatic thyroid cancer symptoms, you can find all of the services you need under a single roof at Moffitt.

    Call or fill out a new patient registration form online to learn more about thyroid cancer treatment services at Moffitt. We welcome patients with or without a referral.

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    Metastatic Lung Cancer Started Someplace Else

    Primary tumors can spread from almost anywhere in the body to your lungs. But some types of cancer are more likely to grow in your lungs. These include:

    • Cancer treatments youâve already had
    • How you want to treat your cancer

    Cancer that has spread to your lungs is also probably in your bloodstream. It could be in places that donât show up on imaging scans. Thatâs why doctors mostly use chemotherapy to treat metastatic lung cancer. It destroys cancerous cells everywhere in your body.

    Surgery Is less common. Doctors use it if the tumors are only in a small part of the lung . It can also help when the primary cancer is colorectal cancer, bone cancer, or soft tissue sarcoma.

    Other treatment options include:

    • Hormonal therapy. This slows the growth of certain types of cancer cells and eases your symptoms.
    • Targeted therapy. It uses medications that attach to proteins on cancer cells to stop or slow their growth.
    • Immunotherapy. This uses your bodyâs immune system to destroy cancer cells.
    • Ablation therapy. It destroys cancer cells or tumors with lasers or electrical currents.
    • Radiation. High energy X-rays are used to destroy tumors.
    • Thoracentesis. This uses a needle to remove fluid in the space between your lungs and chest wall.
    • Oxygen therapy. It helps you breathe.
    • Stents. They open up narrowed airways.

    When Does Metastatic Thyroid Cancer Show Symptoms

    Metastatic thyroid cancer, also known as stage 4 thyroid cancer, refers to cancer that has spread from the thyroid gland to distant areas of the body. This is the most advanced stage of thyroid cancer. At this late stage, many symptoms are likely to be present. In fact, symptoms typically appear at an earlier stage and can often be detected before the thyroid cancer has metastasized.

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    Prognosis Of Thyroid Cancer That Has Spread To Lungs

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    Tg And Tgab Measurement

    Treatment of Recurrent Thyroid Cancer

    The FT3, FT4, TSH, Tg, and TgAb levels were measured before 131I treatment and during follow-up. A cobas® analyzer was used to determine the Tg and TgAb levels using the same high-sensitivity electrochemiluminescence immunoassay method in the same laboratory of our hospital based on the manufacturer’s instructions. Quality control was ensured by assaying the Tg and TgAb levels in control sera in each analytical series, and all sera in which the interassay coefficient of variation exceeded 10% were reassessed. The analytical limit of Tg was 0.1 g/mL with a detection range of 0.1 to 25,000 g/L, and the analytical limit of TgAb was 10 UI/mL with a detection range of 10 to 4,000 IU/mL. A persistently negative Tg level was defined as a preablative stimulated Tg level of < 10 ng/mL at the time of initial 131I therapy or a Tg level of < 0.2 ng/mL or < 1 ng/mL during follow-up . An elevated TgAb level was defined as a TgAb level of 80 IU/mL according to a previous report . TgAb levels were classified into three categories in this study: < 1,000 IU/mL, 1,0004,000 IU/mL, an4,000 IU/mL.

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    Evaluation Of Changes In Serum Tg Level

    After at least two courses of 131I therapy, changes in Tg level were classified into three types: effectiveness ), stabilization and ineffectiveness according to our previously study . i) Effectiveness: compared with pretreatment, the serum Tg levels exhibited a reduction of 25% ii) stabilization: compared with pretreatment, the serum Tg decreased or increased by < 25% and iii) ineffectiveness: compared with pretreatment, the serum Tg increased by 25%.

    Choosing To Stop Treatment Or Choosing No Treatment At All

    For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.

    Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.

    Recommended Reading: How Do You Develop Thyroid Cancer

    Papillary Thyroid Cancer Overview

    Papillary thyroid cancer is the most common of all thyroid cancers . It can also be called papillary thyroid carcinoma since carcinoma implies a certain type of cancer. Since thyroid cancer is relatively common, and papillary thyroid cancer is the most common form of thyroid cancer, it is very likely that you will know somebody that had or has this form of cancer. Papillary thyroid cancer typically starts within the thyroid as growth, or bump on the thyroid that grows out of the otherwise normal thyroid tissue. Papillary thyroid cancer is clearly increasing in its incidence both in the United States and globally–it is one of the few cancers that are becoming more common, but we don’t know why this is happening. Our Introduction to Thyroid Cancer page has a great general overview of all types of thyroid cancer–read it if you haven’t already!

    How Serious Is My Cancer

    Thyroid Cancer Treatment (Adult) (PDQ®)Patient Version

    If you have thyroid cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was stage 1 or stage 2. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

    The stage describes the spread of the cancer through the thyroid gland. It also tells if the cancer has spread to other organs of your body that are close by or far away.

    Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread outside of the thyroid gland. Be sure to ask the doctor about the cancer stage and what it means for you.

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    What Are The Symptoms Of Papillary Thyroid Cancer

    The main sign of papillary thyroid cancer is a painless lump or nodule on your thyroid gland. PTC usually doesnt cause any other symptoms.

    In rare cases, you may experience pain in your neck, jaw or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing or swallowing.

    Cancer May Spread From Where It Began To Other Parts Of The Body

    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

    • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
    • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

    The metastatic tumor is the same type of cancer as the primary tumor. For example, if thyroid cancer spreads to the lung, the cancer cells in the lung are actually thyroid cancer cells. The disease is metastatic thyroid cancer, not lung cancer.

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    Evaluation Of Changes In Chest Ct Images

    Chest CT responses were assessed using Response Evaluation Criteria in Solid Tumors as follows: i) complete response , disappearance of all lesions ii) partial response , 30% decrease in the sum of lesions diameters, taking as reference the baseline sum diameters iii) progressive disease , 20% increase in the sum of lesion diameters or appearance of greater than or equal to one new lesions is also considered progression and iv) stable disease , neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.

    Strategies To Improve Treatment

    The Stigma Of Thyroid Cancer

    Iodine Resensitization: Radioactive iodine is widely used in the treatment of advanced follicular cell-derived thyroid cancers, but patients may become develop radiation resistant disease. This occurs because of down regulation of the sodium-iodide symporter gene .

    Researchers have figured out how to turn or enhance redifferentiation of NIS so that: the cancer cells can be treated with radioiodine again. Retinoids, Selumetinib and Dabrafenib have been shown to restore RAI uptake in advanced patients.10-12

    References:

  • Podnos YD, Smith D, Wagman LD, Ellenhorn JD. Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery. 2005 128:1072-6.
  • Rosenbluth BD, Serrano V, Happersett L, et al. Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer. International Journal of Radiation Oncology Biology Physics. 2005 63:1419-26.
  • De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991 14:475-80.
  • Pak H, Gourgiotis L, Chang WI, et al. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. Journal of Surgical Oncology. 2003 82:10-8.
  • Schlumberger M, Makoto T, Wirth L, et al. The New England Journal of Medicine 372:621-630 February 12, 2015.
  • FDA approves Nexavar to treat type of thyroid cancer. . U.S. Food and Drug Administration website. Available at:
  • Recommended Reading: Doctors Who Specialize In Thyroid

    Magnetic Resonance Imaging Scan

    MRI scans use radio waves and strong magnets instead of x-rays, therefore there is no radiation exposure. A contrast material called gadolinium is often injected into a vein before the scan to better show details.

    MRI of thyroid, neck and chest to evaluate for papillary thyroid cancer.

    MRI of a patient with papillary thyroid cancer of the left thyroid lobe. . The arrow points to the thyroid cancer which is more invasive and aggressive than the usual papillary thyroid cancer. This cancer has spread to the overlying muscles.

    Like CT scans, MRI scans can be used to look for a diagnosis of papillary thyroid cancer in the thyroid, for cancer that has spread to nearby or distant parts of the body. But ultrasound is usually the first choice for looking at the thyroid and neck structures.

    MRI scans are very sensitive to movement and moving during the scanning process produces artifacts that make interpretation difficult. Because people are constantly swallowing and unconsciously moving their voice box and swallowing structures (and therefore their thyroid gland and surrounding lymph nodes, CT of the neck is the preferred cross-sectional study of the neck in patients with a diagnosis of papillary thyroid cancer.

    Ret Alterations Spur Cancer Growth

    RET alterations are rare in cancer overall but more common in lung and thyroid cancers. About 2% of people with non-small cell lung cancer and 10%20% of those with papillary thyroid cancer, the most common type of thyroid cancer, have tumors in which a piece of the RET gene is fused to part of another gene, known as RET fusionpositive cancer. In addition, smaller genetic alterations in RET are found in more than half of all cases of medullary thyroid cancer.

    Although medullary thyroid cancer is rare, the outlook for people with this form of thyroid cancer is worse than for people with papillary thyroid cancer, said LIBRETTO-001 study investigator Lori Wirth, M.D., of Massachusetts General Hospital.

    RET gene fusions and mutations result in the production of abnormal RET proteins, which spur the growth of cancer cells. RET is a type of protein called a kinase, which is involved in various cell processes.

    Selpercatinib was designed to target RET while minimizing its activity against other kinases. Most of the other drugs now in our arsenal that have some activity against RET-altered cancers are multi-kinase inhibitors that target and block the activity of other kinases in addition to RET, Dr. Wirth said.

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