Thyroid cancer that has returned after treatment is called recurrent disease. Most cases of recurrent thyroid cancer occur in the neck region, but some also have distant metastases, or cancer that has spread to distant locations in the body. The most common site of distant metastasis is the lung.
The following is a general overview of treatment for recurrent thyroid cancer. Cancer treatment may consist of radioactive iodine treatment, surgery, radiation, or systemic therapy with precision cancer medicines or chemotherapy, or a combination of these treatment techniques. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.
The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.
Treatment for Recurrent Thyroid Cancer
Treatment for recurrent thyroid cancer depends on many factors, including prior treatment, the cell type that is now cancerous, whether the cells will respond to radioactive iodine treatment, site of recurrence, and other individual considerations.
Surgery is often a key component of treatment for recurrent thyroid cancer, followed by repeated radioiodine treatments.
However, some patients with recurrent disease are resistant to radioactive iodine treatment, meaning their thyroid cells do not take up the iodine. Treatments are more limited for these patients, they may benefit from systemic therapy with newer precision cancer medicines, or participating in a clinical trial evaluating new, innovative approaches to treating thyroid cancer.
If patients with recurrent thyroid cancer have not already had their thyroid removed, they will likely undergo a total thyroidectomy to remove the rest of their thyroid and any other cancer in the neck region. Patients who have had their thyroid removed also often have recurrent cancer in the neck region and will undergo surgery to have as much of the cancer as possible removed.
Radioactive Iodine Treatment
Iodine is a natural substance that the thyroid uses to make thyroid hormone. The radioactive form of iodine is collected by the thyroid gland in the same way as non-radioactive iodine. Since the thyroid gland is the only area of the body that uses iodine, the radiation does not concentrate in any other areas of the body. The radioactive iodine that is not taken up by thyroid cells is eliminated from the body, primarily in urine. It is therefore a safe and effective way to test and treat thyroid conditions.
Research indicates that treatment with radioactive iodine improves survival for patients with thyroid cancer that has spread to nearby lymph nodes or to distant locations in the body.1
Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy
Systemic therapy is any treatment directed at destroying cancer cells throughout the body and consists of chemotherapy and precision cancer medicines. Chemotherapy has not been very effective but newer precision cancer medicines appear promising.
Precision Cancer Medicines
The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the thyroid cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are just beginning to undergo evaluation in thyroid cancer.
Tafinlar & MeKinist: Up to 44 percent of papillary thyroid cancer patients have a genetic mutation called BRAF that can be specifically targeted by existing cancer drugs. The BRAF gene belongs to a class of genes known as “oncogenes,” which send signals to normal cells that cause them to become cancerous. Studies show that Tafinlar alone or combined with MeKinist are well tolerated by patients, resulting in a 50 to 54 percent response rate among the patients advanced BRAF-mutated papillary thyroid cancer.2
Lenvatinib: As an oral anti-angiogenic therapy that targets new blood vessel growth, lenvatinib can “starve” cancer of the nutrients it needs to grow. Overall 65% of refractory thyroid cancer patients experienced a partial or complete disappearance of their cancer following treatment with levatinib. They survive on average 18.3 months without cancer progression compared to 3.6 months for individuals not treated with levatinib.3
Cometriq (cabozantinib) Although medullary thyroid cancers only account for approximately 2-3% of all thyroid cancers they tend to have a somewhat worse prognosis than more common types of thyroid cancer. Cometriq is a precision cancer medicine – a tyrosine kinase inhibitor. It targets specific biological pathways that contribute to the growth of several types of cancer, including the receptor tyrosine kinase RET as well as MET and VEGFR2. The drug is approved for the treatment of metastatic medullary thyroid cancer.
Nexavar (sorafenib): Differentiated thyroid cancer is the most common type of thyroid cancer and can often be cured with surgery and radioactive iodine (RAI) treatment. In some cases, however, the cancer is resistant to RAI. RAI-resistant thyroid cancers have had few effective treatment options.
Nexavar is an oral medicine that works by inhibiting certain proteins that contribute to cancer growth. It has been approved for use in patients with locally recurrent or metastatic, progressive differentiated thyroid cancer that no longer responds to RAI treatment because nexavar increased progression-free survival by 41 percent compared to treatment with a placebo.4
Sutent (sunitinib): Sutent is a targeted therapy that is approved for the treatment of several cancers. It works by inhibiting multiple proteins in cancer cells to limit cancer cell growth and division and is active in the treatment of thyroid cancer.5
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period. Doctors have observed that chemotherapy may help relieve symptoms of advanced thyroid cancer and may increase survival of some patients.6
Strategies to Improve Treatment of Thyroid Cancer
The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of recurrent thyroid cancer will result from the continued evaluation of new precision cancer medicines in clinical trials.
Larotrectinib: Clinical data from three ongoing larotrectinib (LOXO-101) clinical trials in patients whose tumors harbor tropomyosin receptor kinase (TRK) fusions demonstrating a 76 percent confirmed objective response rate (ORR) across tumor types. Larotrectinib targets a mutation where two genes join together in what’s known as TRK fusion, leading to the production of proteins that cause cancer growth.
1 Podnos YD, Smith D, Wagman LD, Ellenhorn JD. Radioactive iodine offers survival improvement in patients with follicular carcinoma of the thyroid. Surgery. 2005;128(6):1072-6.
3 Schlumberger M, Makoto T, Wirth L, et al. The New England Journal of Medicine; 372:621-630 February 12, 2015.
4 FDA approves Nexavar to treat type of thyroid cancer. [FDA News Release]. U.S. Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm376443.htm
5 Advanced Thyroid Cancer Responds to Targeted Therapy with Sunitinib [press release]. Endocrine Society website. Available at: https://www.endocrine.org/news-room/current-press-releases/advanced-thyroid-cancer-responds-to-targeted-therapy-with-sunitinib.
6 De Besi P, Busnardo B, Toso S, et al. Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. Journal of Endocrinology Investigation. 1991;14(6):475-80.