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The Role of Targeted Therapies or Nonsurgical Treatment of Thyroid Malignancies: Is Surgery Being Replaced?

  • Daniel C. McFarlandEmail author
  • Indu Varier
  • Krzysztof Misiukiewicz

Abstract

Targeted therapies are emerging rapidly and are challenging the traditional roles of nonsurgical therapy for the treatment of thyroid cancers. Molecular pathways hold the key for designing rationally based drugs such as the already FDA-approved tyrosine kinase inhibitors: sorafenib, vandetanib, and cabozantinib. Many more targeted therapies are under investigation. For instance, selumetinib is a MEK inhibitor that has been shown to restore radioiodine avidity to radioiodine refractory thyroid cancers. This chapter reviews standard nonsurgical treatments including the historical use of cytotoxic chemotherapy, the molecular science behind newly approved and experimental targeted agents, and their supporting clinical trial data. Lastly, the chapter presents four common scenarios in thyroid cancer management where an increased role is forthcoming for nonsurgical modalities such as tyrosine kinase inhibitors. These cases contrast the cutting edge use of pharmacology, as monotherapy or in combination, with the current held standard of care. Nonsurgical modalities for thyroid cancer care are rapidly advancing, and the best use of these modalities has yet to be established as highlighted in the cases.

Keywords

Thyroid cancer Targeted therapy Tyrosine kinase inhibitor Well-differentiated radioiodine-resistant thyroid cancer Novel therapy Anaplastic thyroid cancer Medullary thyroid cancer Refractory thyroid cancer 

Abbreviations

Akt

Also known as protein kinase B

Braf

v-raf murine sarcoma viral oncogene homolog B1l DNA, deoxyribonucleic acid

ERK

Extracellular signal-regulated kinases

HDAC

Histone deacetylase inhibitor

Mek

Mitogen-activated protein kinase

mTOR

Mammalian target of rapamycin

PI3K

Phosphoinositide 3-kinase

Ras

Rat sarcoma proteins

RET TKR

Rearranged during transfection tyrosine kinase receptor

TKR

Tyrosine kinase receptor

VEGFR

Vascular endothelial growth factor receptor

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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Daniel C. McFarland
    • 1
    Email author
  • Indu Varier
    • 2
  • Krzysztof Misiukiewicz
    • 3
  1. 1.Internal Medicine, Division of Hematology and OncologyMount Sinai Medical CenterNew YorkUSA
  2. 2.Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonUSA
  3. 3.Hematology and Medical OncologyMount Sinai HospitalNew YorkUSA

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