Unpacking the Future of Thyroid Cancer Treatment

Marcia S. Brose, MD, PhD, FASCO, professor in the Department of Medical Oncology Sidney Kimmel Medical College Thomas Jefferson University, professor and vice chair in the Department of Medical Oncology Jefferson Northeast, chief of Cancer Services, Sidney Kimmel Cancer Center-Jefferson Northeast, associate director of Community Based Clinical Research, and SKCC chair of Hematology/Oncology, Jefferson Torresdale Hospital, discusses potential next steps for approaching and treating patients with advanced or metastatic RET-mutant thyroid cancer.

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0:10 | We've gotten a little bit spoiled with the results from selpercatinib [Retevmo], and I think that there's a hope that we often can anticipate. This is a class of drugs that we've seen and used in lung cancer, melanomas, thyroid cancer, and many other cancers. We can already predict often how the resistance develops to these agents. I think the next stage for the patients who have mutations is to see if there are, again, ways that we can target those mutations specifically, in a way that's refined with low [adverse] effects and good results. [Also, I hope] we continue this sort of line of successful therapies for the patients who have mutations. That’s number 1.

1:02 | Number 2, there are mutations that are very common, like RAS, and unlike KRAS, which we have now lots of inhibitors for, most of the mutations in thyroid cancer are HRAS. I would love to see an HRAS inhibitor that we can give to those patients, because they tend to not do as well. HRAS mutations are pretty prevalent.

1:33 | I think we have some more targets we need to go after, and we can follow-up on patients who have resistance. Now interestingly, we know of that happening in lung cancer because they don't get quite as long a progression-free survival as they got with selpercatinib. There's already some work being done, and most of the patients [with] lung cancer can be studied in that way. Interestingly, even from LIBRETTO-001 [NCT03157128], many of our patients from that first trial are still responding 3 or 4 years later, so we haven't needed to study it or even had the patience to study the resistance mechanisms yet, but we are starting to see them now. We hope that we're going to have good, targeted therapy for them as well.