Applying NGS in Thyroid Cancer and Other Head and Neck Cancers

Everett E. Vokes, MD, the John E. Ultmann Distinguished Service professor of Medicine, professor of Radiation and Cellular Oncology, chair of the Department of Medicine, and physician-in-chief, at University of Chicago Medicine and Biological Sciences, discusses the clinical application of next-generation sequencing (NGS) for head and neck cancers, including thyroid cancers.

According to Vokes, there are a few targets that are important for determining which therapy to give a patient. For example, BRAF mutations and HRAS mutations. This holds true even though patients are most likely to receive a multi kinase inhibitor in the frontline setting. For example, lenvatinib (Lenvima) is an FDA approved therapy for the treatment of a thyroid cancer subset.

Vokes mentions that although PD-L1 is considered molecular testing rather than NGS, it is still clinically relevant when determining treatment for some patients with thyroid cancer.

Transcript:

0:08 | Is it worthwhile to do that routinely? I think it's thyroid cancer, yes. Even though a broad kinase inhibitors such as lenvatinib might be the first-line of what we would use, if there's another mutation like BRAF or something else, that may lead to, you know, a more informed decision.

0:30 | In subsequent therapies when, invariably, the patients get refractory to the initial treatment for squamous cell tumors, well, for HRAS, it's worth looking at whether there is a target. We do test for PD-L1 and PD-L1 it is of probably some relevance. There may be an occasional patient, one could treat with a PD-1 inhibitor by itself. But most patients will get a PD-1 inhibitor together with chemotherapy. Now, that's not next generation, but I think PD-L1 testing is worth it. And next-generation sequencing, I think certainly in a center such as ours, we do that often.