Stratifying Patients With Pediatric Versus Adult Thyroid Cancer

Aime T. Franco, PhD, assistant professor and investigator with the Center for Childhood Cancer Research at Children's Hospital of Philadelphia, discusses how recent research has explored the difference between pediatric thyroid cancer and adult thyroid cancer at the 91st Annual Meeting of the American Thyroid Association.

According to Franco, a key difference is that pediatric thyroid cancers can be classified in 3 groups: those associated with BRAF mutations, those associated with RAS mutations, and those associated with oncogenic fusions. Oncogenic fusions are more common in pediatric cancers than adult thyroid cancers and tend to be more invasive with greater risk of recurrence and metastasis.

Though pediatric thyroid cancers are rare in the general population, Franco says that multicenter studies through collaborations and consortiums have enabled researchers to identify these 3 subtypes. Studies have also allowed researchers to learn more about the progression of the disease. More research is needed into what can be done to treat recurrent disease. A key question is whether pediatric patients need to be treated like adult patients as they mature.

TRANSCRIPTION:

0:08 | In recent years, what's been so unique is for us to start to understand the fact that pediatric thyroid cancers tend to look like there are 3 main groups based on their mutations, whether they're driven by BRAF mutations, which we see in adult tumors, whether they're driven by RAS mutations, which we also see in the adult tumors, but interestingly, in pediatrics, we see a lot of fusion-driven tumors that are driven by oncogenic fusion events. Although we see these in the adult cases, they tend to be much [rarer] than they are in the pediatric space. In the pediatric space, they represent their own bucket.

0:48 | These tumors we're seeing, it looks like they behave differently; they can be more invasive [and] they tend to have a greater risk for recurrence and for metastasis. We're still working and collaborating [not only] within our group, but in many others to expand the number of samples we've looked at, because thyroid cancer in the pediatric setting is still a rare cancer. It is difficult to get real power in large studies without doing multi-institutional studies, which is exactly what we're doing now, and starting new collaborations and consortiums. But it looks like pediatric tumors really kind of fall in these 3 buckets, whereas the adult tumors tend to fall in 2 buckets.

1:35 | This is going to change how we think about treating the disease as well as stratifying these patients for their long term follow up and how we think about it, again, as this lifespan disease. And as these pediatric patients start to become adults, or are their tumors going to, if they have persistent disease, continue to act like pediatric tumors, or are they going to act like adult tumors? And that's an open-ended question at this point.