Thyroid Cancer

Thyroid Cancer

Thyroid Cancer Part 1

Which RET fusion is most common in non-MTC thyroid cancer ? 

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 CCDC6

Thyroid Cancer Part 1
Thyroid Cancer Part 1

Does selpercatinib have activity in TKI pre-treated advanced medullary thyroid cancer? 

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Yes as ORR >60% reported

 

Thyroid Cancer Part 1
Thyroid Cancer Part 1

What is the most common mutation seen in RET mutated medullary thyroid cancer ? 

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 M918T

 

Thyroid Cancer Part 1
Thyroid Cancer Part 1

Does selpercatinib have activity in non-medullary thyroid cancer ? 

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Yes

 

Thyroid Cancer Part 1
Thyroid Cancer Part 1

What are 2 common demographic features of follicular thyroid cancer?

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median age of 60 and female gender

Thyroid Cancer Part 1
Thyroid Cancer

What percentage of thyroid cancers are follicular?

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Approximately 12%

Thyroid Cancer
Thyroid Cancer

What are some features of low risk papillary thyroid disease?

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No local or distant metastases, R0 resection, no invasion of local regional tissue, no aggressive histology
features, no vascular invasion, no iodine-131 uptake outside of the thyroid bed, no lymph node
involvement, less than or equal to 5 micrometastases in the lymph nodes, less than 2 mm in largest
dimension

Thyroid Cancer
Thyroid Cancer

What defines N1 disease in thyroid cancer?

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Metastases to regional nodes including pretracheal, paratracheal, prelaryngeal, upper mediastinal, level
I, 2, 3, 4, 5 lateral neck lymph nodes

Thyroid Cancer
Thyroid Cancer

What defines T4 in thyroid cancer?

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Growth with extrathyroid extension beyond the strap muscles

Thyroid Cancer
Thyroid Cancer

What can help distinguish multiple endocrine neoplasia type 2B from 2A?

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2B does not have hyperparathyroidism

Thyroid Cancer
Thyroid Cancer

What is the inheritance pattern of multiple endocrine neoplasia?

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Autosomal dominant for both types

Thyroid Cancer
Thyroid Cancer

Which familial syndrome should be considered in medullary thyroid cancer?

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Multiple endocrine neoplasia

Thyroid Cancer
Thyroid Cancer

What is the most common presentation of medullary thyroid cancer?

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Thyroid nodule

Thyroid Cancer
Thyroid Cancer

What serum test should be checked in patients with biopsy-proven medullary thyroid cancer?

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Calcitonin

Thyroid Cancer
Thyroid Cancer

What dose of radioactive iodine-131 is recommended for lymph node metastases in the neck?

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150 mCi

Thyroid Cancer
Thyroid Cancer

What dose of iodine-131 is recommended for pulmonary metastases?

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150 mCi

Thyroid Cancer
Thyroid Cancer

What is the purpose of rhTSH administration prior to radioactive iodine treatment?

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To increased TSH levels, hence causing increased iodine uptake

Thyroid Cancer
Thyroid Cancer

How many days after treatment with 200 mCi radioactive iodine can patients return to work?

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1

Thyroid Cancer
Thyroid Cancer

How many days after treatment with radioactive iodine and radiation can detectors at airports be
triggered?

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95 days

Thyroid Cancer
Thyroid Cancer

How long should patient wait after treatment with radioactive iodine before becoming pregnant?

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6 months

Thyroid Cancer
Thyroid Cancer

What dose of radioactive iodine is appropriate for pregnant patients?

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None, Completely contraindicated.

Thyroid Cancer
Thyroid Cancer

Is radioactive iodine excreted by the kidney or the liver?

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Kidney

Thyroid Cancer
Thyroid Cancer

When would use a dose of 200 mCi radioactive iodine – 131 in the adjuvant setting?

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Nonpulmonary distant metastases such as liver and bone

Thyroid Cancer
Thyroid Cancer

Can you perform a lobectomy with isthmusectomy with multifocal medullary thyroid cancer?

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No

Thyroid Cancer
Thyroid Cancer

How many foci of papillary thyroid cancer are allowed to have unilateral lobectomy with
isthmusectomy?

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5 or less

Thyroid Cancer
Thyroid Cancer

Which patients should get prophylactic central lymph node dissection?

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Tumors larger than 4 cm, positive lymph nodes, extrathyroid extension

Thyroid Cancer
Thyroid Cancer

What serum test needs to be checked before and after thyroidectomy?

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Calcium

Thyroid Cancer
Thyroid Cancer

When wold you consider a thyroid lobectomy and isthmusectomy?

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Tumors less than 1cm (or 4cm with experienced surgeon)

Thyroid Cancer
Thyroid Cancer

What size cut-off warrants a total thyroidectomy for medullary thyroid cancer without extra thyroid
extension or metastases?

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4 cm

Thyroid Cancer
Thyroid Cancer

In patients with medullary thyroid cancer with metastatic disease, is there any indication for
thyroidectomy?

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Yes, depends on the clinical scenario

Thyroid Cancer
Thyroid Cancer

If a patient with medullary thyroid cancer is found to have lymph node involvement but no distant
metastases after thyroidectomy, what adjuvant therapy is recommended?

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Radiotherapy

Thyroid Cancer
Thyroid Cancer

What serum calcitonin cut-off is recommended for metastatic workup in the preoperative setting for
medullary thyroid cancer?

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500 pg/mL

Thyroid Cancer
Thyroid Cancer

In patients with newly diagnosed RET mutated medullary thyroid cancer what other workup is
necessary?

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Pheochromocytoma and hyperparathyroidism

Thyroid Cancer
Thyroid Cancer

Which neoplasias can be seen in multiple endocrine neoplasia type 2A?

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Hyperparathyroidism, pheochromocytoma, medullary thyroid cancer

Thyroid Cancer
Thyroid Cancer

What laboratory test correlates well with medullary thyroid tumor diameter?

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Serum calcitonin levels

Thyroid Cancer
Thyroid Cancer

Which germ line testing is required for patients with newly diagnosed medullary thyroid cancer?

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RET

Thyroid Cancer
Thyroid Cancer

What cells do medullary thyroid cancers originate from?

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Calcitonin producing parafollicular C cells of the thyroid

Thyroid Cancer
Thyroid Cancer

What cardiac side effects can be seen on EKG with vandetinib?

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QT prolongation

Thyroid Cancer
Thyroid Cancer

What is required when using vandetinib?

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REMS enrollment

Thyroid Cancer
Thyroid Cancer

What are the targets of lenvatinib?

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RET, VEGFR, FGFR

Thyroid Cancer
Thyroid Cancer

Which TKIs are active in metastatic differentiated thyroid cancer?

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Lenvatinib, sorafenib, cabozantinib, pazopanib, vandetaninb, Sunitinib

Thyroid Cancer
Thyroid Cancer

Which cytotoxic chemotherapy agent is active in differentiated thyroid cancer?

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Doxorubicin

Thyroid Cancer
Thyroid Cancer

What is first-line treatment for radioactive iodine resistant metastatic papillary thyroid cancer?

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TKI

Thyroid Cancer
Thyroid Cancer

Patients with metastatic papillary thyroid cancer, can undergo surveillance under which circumstance?

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Tumors less than 2 cm and growing no more than 20% per year

Thyroid Cancer
Thyroid Cancer Part 2

Is there randomized data supporting the use of sorafenib in progressive medullary thyroid cancer ?

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No

Thyroid Cancer Part 2
Thyroid Cancer

What was the comparator arm in LPS14811 with vandetanib in progressive medullary thyroid cancer ?

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Placebo

Thyroid Cancer
Thyroid Cancer

What was the most common AE (all grades) with vandetanib in LPS14811 ?

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Diarrhea

Thyroid Cancer
Thyroid Cancer

Which trial assessed the utility of vandetanib in progressive medullary thyroid cancer ?

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LPS14811

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Thyroid Cancer

Was an OS demonstrated in the EXAM trial ?

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No, only PFS

Thyroid Cancer
Thyroid Cancer

What was the comparator arm in the EXAM trial for cabozantinib ?

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Placebo

Thyroid Cancer
Thyroid Cancer

Which trial assessed the utility of cabozantinib in progressive medullary thyroid cancer ?

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EXAM

Thyroid Cancer
Thyroid Cancer

Which VEGFR inhibitors have randomized phase 3 trials showing improvements in PFS for progressive medullary thyroid cancer ?

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Cabozantinib and vandetanib

Thyroid Cancer
Thyroid Cancer

Which BRAF/MEK inhibitor has demonstrated efficacy in BRAF V600 mutated metastatic anaplastic thyroid cancer ?

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Dabrafenib/trametinib

Thyroid Cancer
Thyroid Cancer

Is there randomized date for vandetanib in progressive differentiated thyroid cancer ?

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Yes, Phase II, Leboullex et al. Lancet 2012

Thyroid Cancer
Thyroid Cancer

What did the DECISION trial assess for thyroid cancer ?

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Improvement in PFS with sorafenib in differentiated iodine refractory thyroid cancer

Thyroid Cancer
Thyroid Cancer

Which type of thyroid cancer was assessed in the DECISION trial ?

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Differentiated iodine refractory thyroid cancer

Thyroid Cancer
Thyroid Cancer

Was an OS demonstrated in the SELECT trial ?

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No, crossover was allowed

Thyroid Cancer
Thyroid Cancer

What was the comparator arm in the SELECT trial ?

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Placebo

Thyroid Cancer
Thyroid Cancer

Which trial assessed the efficacy of Lenvatinib in differentiated thyroid cancer progressing on I-131 ?

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SELECT

Thyroid Cancer
Thyroid Cancer

Is there randomized data supporting the use of sunitinib in progressive medullary thyroid cancer ?

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No

Thyroid Cancer
Thyroid Cancer

Which genetic mutation predicts for higher recurrence in papillary thyroid cancer?

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BRAF

Thyroid Cancer
Thyroid Cancer

What is the 20 year cancer-related mortality for papillary thyroid cancers less than 4cm?

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6%

Thyroid Cancer
Thyroid Cancer

Which syndromes increase the risk for developing papillary thyroid cancer?

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familial polyposis, Cowden syndrome,Carney complex, multiple endocrine neoplasia type 2
[MEN2], Werner syndrome

Thyroid Cancer
Thyroid Cancer

When would you consider a surveillance PET scan for DTC?

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Tg > 10ng/mL

Thyroid Cancer
Thyroid Cancer

When would you consider a surveillance CT/MRI of the neck for DTC?

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High-risk patients with rising Tg or high clinical suspicion of recurrence

Thyroid Cancer
Thyroid Cancer

Where is the most common site of recurrent papillary thyroid cancer?

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Cervical LN

Thyroid Cancer
Thyroid Cancer

Which isotope of iodine is used for radioactive ablation of DTC?

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I-131

Thyroid Cancer
Thyroid Cancer

What modalities are used to monitor DTC patients after any surgical resection during the first year?

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TSH, Tg, and Neck US

Thyroid Cancer
Thyroid Cancer

What is the TSH goal for ATA high risk patients ?

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<0.1IU/L

Thyroid Cancer
Thyroid Cancer

What are some high risk features of papillary thyroid cancer ?

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Macroscopic tumor invasion, incomplete tumor resection with gross residual disease, distant
metastases, post-operative serum thyroglobulin suggestive of distant metastases, pathologic N1 with
any metastatic lymph nodes >/= 3cm, follicular thyroid cancer with extensive vascular invasion.

Thyroid Cancer
Thyroid Cancer

What non-stimulated thyroglobulin levels can be expected after a total thyroidectomy ?

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<5 ng/mL after a total thyroidectomy

Thyroid Cancer
Thyroid Cancer

What are some indications for a total thyroidectomy ?

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Total thyroidectomy is recommended if the primary tumor is 4 cm in diameter or greater, there is
extrathyroidal extension of tumor, or there are metastases to lymph nodes or distant sites,
childhood head and neck radiation, multifocal papillary thyroid cancer with more than 5 foci

Thyroid Cancer
Thyroid Cancer

What is the least common histology for thyroid cancer ?

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Anaplastic

Thyroid Cancer
Thyroid Cancer

What is the most common thyroid cancer histology?

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Papillary – 85%

Thyroid Cancer
Thyroid Cancer

Should high risk papillary thyroid cancer patients always receive adjuvant radioactive iodine?

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Yes

Thyroid Cancer
Thyroid Cancer

Should intermediate risk papillary thyroid patients received radioactive iodine?

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Only if high risk features are present

Thyroid Cancer
Thyroid Cancer

Should low risk papillary thyroid patients receive radioactive iodine?

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No

Thyroid Cancer
Thyroid Cancer

Which genetic mutation can be seen in anaplastic thyroid cancer?

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BRAF V600E

Thyroid Cancer
Thyroid Cancer

Which chemotherapy agents are active in anaplastic thyroid cancer?

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Doxorubicin, docetaxel, cisplatin

Thyroid Cancer
Thyroid Cancer

What is the most common presentation of anaplastic thyroid cancer?

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Rapidly enlarging neck mass

Thyroid Cancer
Thyroid Cancer

What is an important feature of performing serial thyroglobulin measurements?

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Use the same assay as there is inter-assay variability

Thyroid Cancer
Thyroid Cancer

What is the most common metastatic site for follicular thyroid cancer?

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Bone

Thyroid Cancer
Thyroid Cancer

What is the most common mode of dissemination for follicular thyroid cancer?

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Hematologic

Thyroid Cancer
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