Investigational Therapies for Thyroid Cancer

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Beyond sorafenib and lenvatinib, other agents have also shown a clinical activity in the thyroid cancer setting, states Robert I. Haddad, MD. Some of these agents are currently available, while others are still in the testing phases.

Haddad shares the following options:

• Pazopanib: a tyrosine kinase inhibitor, approved for renal cell carcinoma and other indications and currently in a phase II trial for advanced thyroid disease
• Vandetanib: a multikinase inhibitor, approved for medullary thyroid carcinoma (MTC) and currently in phase II studies for patients with more aggressive types of thyroid cancer
• Vemurafenib: a BRAF inhibitor, approved for metastatic melanoma. Has shown activity in phase II trials for patients with thyroid cancer
• Everolimus: an mTOR inhibitor, with several ongoing trials, including combination studies
• Cabozantinib: a multikinase inhibitor, currently approved for MTC, and being tested for RAI-resistant thyroid cancer

Along with vemurafenib, Haddad adds, the entire class of BRAF inhibitors is being tested in patients with BRAF mutations. Another area of ongoing investigation is immunotherapy, which may be tested as a stand-alone approach or in combination with some of the VEGF inhibitors.

Since the best approach in patients who have progressed on sorafenib and lenvatinib is unknown, Haddad notes that the next step in care would be enrollment in a clinical trial, but stresses the importance of profiling to determine which trial would be best.