Molecular Profiling and Targeted Therapy for Thyroid Cancer
- In cancer, targeted therapies go after specific features of the cancerous cells — allowing for a more precise approach to cancer care. These approaches can be more effective and reduce the risk of side effects.
- “The vast majority, over half of all thyroid cancer in the advanced state, harbors some sort of molecular aberration, like a mutation or a fusion protein, that lends itself to different targeted therapies,” Dr. Jessica Geiger, a medical oncologist who specializes in head and neck cancers at Cleveland Clinic, tells SurvivorNet.
- The BRAF mutation is one of the more common markers for thyroid cancer — and it can be treated with a drug known as a BRAF inhibitor.
- Molecular profiling is frequently a key part of the diagnostic process in the world of cancer care today — and patients should speak to their doctors about the risks/benefits of undergoing testing.
Some thyroid cancers with specific molecular profiles are more likely to respond to treatments known as targeted therapies — and understanding the molecular profile is particularly important for patients with advanced disease.
Read MoreBRAF Mutations: What Should You Know
Some people with thyroid cancer (like papillary type, the most common thyroid cancer) have a change in a gene called BRAF. This change, called a BRAF mutation, usually does not occur in other thyroid conditions like benign (noncancerous) nodules or a different type of thyroid cancer called follicular carcinoma.
This mutation will guide doctors in several ways, including:
- Diagnosis and Monitoring: In some studies, patients with papillary thyroid cancer who tested positive for the BRAF mutation sometimes had cancer that remained after treatment or had spread (metastasized). This information may help doctors know which patients need closer follow-up or more aggressive treatment.
- How Testing Works: Doctors can look for a BRAF mutation in a small sample of thyroid cells taken by a fine-needle aspiration biopsy or, in some cases, through blood tests. Finding the BRAF mutation suggests that the thyroid cancer is likely papillary and may guide treatment decisions.
- Treatment Possibilities: Research in lab settings shows that special medications, called “selective BRAF inhibitors,” can slow down the growth of thyroid cancer cells that have a BRAF mutation. This opens the door for new treatment approaches specifically aimed at patients whose papillary thyroid cancer has this gene change.
Targeted Treatment With BRAF Inhibitors
Undoubtedly, discovering a BRAF mutation can be an important piece of information for your thyroid cancer care team. It helps with diagnosing papillary thyroid cancer and may offer additional treatment options if the mutation is present. These options are called BRAF inhibitors.
“We have targeted therapies that can work very well and work very quickly,” Dr. Geiger explains.
For BRAF mutations, “the most common [medications] we use are a combination of BRAF and MEK inhibitors because they work together, and it’s called debrafenib and trametinib,” she adds. “You take them everyday. The trametinib you take once a day, the dabrafenib is a twice-daily pill that you take, and again, it targets that molecular mutation that is driving growth and progression and the development of that cancer.”
BRAF Inhibitors: Side Effects
Patients respond to targeted therapies differently, but some of the more common side effects include:
- Skin problems (rashes, sun sensitivity)
- Fatigue/weakness
- Muscle/joint pain
- Fever
- Digestive issues (nausea, diarrhea, loss of appetite)
- Hair thinning or temporary hair loss
Always let your doctor know about any side effects or new symptoms. They can suggest ways to help you manage or reduce these problems. Many of these symptoms can be reduced by implementing some simple daily habits — like wearing sunscreen and protective clothing, staying hydrated, and maintaining a balanced diet.
Other Mutations for Thyroid Cancer
BRAF is not the only mutation that can make a difference in the approach to thyroid cancer treatment.
“There are RET mutations that are found in a lot of medullary thyroid cancer,” Dr. Geiger explains, noting there are RET fusion products to target these.
“So these are different parts of the DNA that are kind of fused together to form a fusion, and they can be found in 10% or so of differentiated thyroid cancer as well, like papillary thyroid cancer,” she adds.
Questions to Ask Your Doctor
- Will I be tested for genetic mutations?
- Do you recommend targeted therapy in my case?
- What potential side effects should I be aware of?
- Should my family members be tested?
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