J.Jpn. Surg. Soc.. 124(1): 50-56, 2023

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NOVEL DRUG THERAPY FOR THYROID CANCER

Introduction: Molecularly targeted drugs were first approved by insurance providers for RAI-refractory advanced thyroid cancer treatment in Japan in 2014. Recently, entrectinib, larotrectinib, pembrolizumab, and selpercatinib have been approved for thyroid cancer, although companion genomic testing is required for diagnosis. In this article, we discuss the results of drug therapy for advanced thyroid cancer and the timing of genomic testing.
Outcome: Since 2014, 126 patients with differentiated thyroid cancer have been treated with molecularly targeted agents in our department. The median overall survival time was 41.6 months. There were 54 deaths, 55 patients on treatment, and 17 patients on dose interruption.
Genomic testing: A total of 20 patients have undergone genomic testing so far, with the BRAF mutation being the most common （in 16/20 patients, 80.0％）. In 2 cases, a therapeutic agent was found through testing. The results were compared with genomic testing of 13 cases of anaplastic thyroid cancer.
Conclusion: Although genomic testing is performed in patients who are unable to continue first-line therapy, unfortunately, the number of patients who are eligible for second-line therapy is limited. The future challenge is to increase the number of cases to which second-line drugs can be administered by accelerating genomic testing and clarifying the mechanism of anaplastic transformation.

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