Treatment Sequencing and Strategies in Thyroid Cancer Care

Francis P. Worden, MD, professor of medicine at the University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, discusses future plans to investigate combination therapies and other novel treatments in the thyroid cancer space.
According to research by Worden et al, combining lenvatinib (Lenvima) with pembrolizumab (Keytruda) upfront showed no additional benefit over lenvatinib alone. However, patients who progressed on lenvatinib and then received pembrolizumab, experienced some disease stability, suggesting a potential benefit in continuing lenvatinib before switching to other therapies like cabozantinib (Cabometyx).

Now, new agents are under investigation, but their potential benefits are still uncertain and no studies are ongoing to explore additional combinations with lenvatinib beyond what has already been published.

Transcription:

0:09 | We have data that are reasonably accepted for publication with immunotherapy and lenvatinib. Interestingly enough, when lenvatinib was combined with pembrolizumab upfront, we were hoping to see complete responders and we did not appreciate that. Essentially, the progression-free survival is similar to what we saw on SELECT [NCT01321554]. The addition of immunotherapy to the TKI or lenvatinib upfront did not necessarily provide any additional benefit.

0:44 | Now when [patients] were on lenvatinib in the second cohort and progressed at whatever dose they were on by RECIST criteria within this 12-to-14-month timeframe, we added in pembrolizumab. Some of those patients showed some stability of disease.

1:09 | Now, one could argue and say this is the long-term effect of lenvatinib, but I know in my clinical practice I have seen [patients] who were progressing and that was the nature of the entry criteria. [Patients] had to be progressing in order to have the addition of pembrolizumab and I have seen some patients who had disease that became stable. So, there is a group of patients that I may consider as an opportunity to continue lenvatinib before cabozantinib or a different targeted therapy.

1:52 | There are other agents that are being investigated, but they are kind of in the early phase. So we have to wait for the results to see if there could be any benefit. But in terms of the addition of other drugs to lenvatinib outside of the published study we just talked about, there really is not anything ongoing where we are going to add lenvatinib to see if things improve or not.