Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, discusses treatment options for patients with anaplastic thyroid cancer.

There are approved treatments but they are not particularly effective, explains Dadu. Therefore, clinical trials have been used as first-line therapy for patients with metastatic anaplastic thyroid cancer.

Right now, targeted therapy holds the hope for being the next approach for treatment for these patients but there is also interest in the combination of targeted therapy with immunotherapy, states Dadu.

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Dr. Dadu on Treatment Options for Thyroid Cancer

Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, discusses the use of immunotherapy to treat patients with thyroid cancer.

Dadu begins by explaining the interaction between the immune system and the cancer cells which, she says, is quite complex. A comprehensive evaluation of these tumors is needed in order to properly classify them as immunogenic, or "hot" tumor environments.

Dadu defines a "hot" immunogenic environment as one that has a lot of tumor infiltration into lymphocytes within the tumor microenvironment, but the tumor cells themselves also express high levels of PD-L1, making the environment exhausted in a sense.

To date, she says, the field lacks a good predictive marker to inform oncologists about which patients will respond to immunotherapy and which will not. Dadu hopes that, by identifying these immune infiltrates and PD-L1 expression, researchers can move the treatment landscape forward. As of now, she explains, few patients with thyroid cancer have actually been treated with immunotherapy, meaning the available data are quite limited.

Dr. Dadu on Immunotherapy in Thyroid Cancer

Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, discusses treatment approaches in medullary thyroid cancer.

According to Dadu, medullary thyroid cancer is somewhat non-immunogenic, as there are few immune cells that infiltrate within the tumor microenvironment. However, there are some patients who have increased levels of certain lymphocytes, as well as PD-L1 expression on tumor cells.

While there is a small subset of patients for whom immunotherapy may be effective, the best approach is likely a combinatorial regimen involving an agent that can make that tumor microenvironment more immunogenic, says Dadu.

Going forward in this treatment landscape, Dadu says that combination approaches incorporating both targeted therapy and immunotherapy may work best for these patients.

Dr. Dadu on Treatment Approaches in Medullary Thyroid Cancer

Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, discusses the current treatment approaches being evaluated for patients with anaplastic thyroid cancer (ATC).

While there are approved treatments in this setting, Dadu says that most of them do not demonstrate very efficacious results for patients. Therefore, clinical trials often serve as first-line therapies for metastatic ATC.

Targeted therapies have been explored in this setting, though recent results have shown quite short progression-free survival (PFS) rates. Perhaps adding immunotherapy to targeted therapy, explains Dadu, will lead to improved PFS and overall survival rates.

Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, discusses the current treatment approaches being evaluated for patients with anaplastic thyroid cancer.

Dr. Dadu on Current Treatment Approaches in Anaplastic Thyroid Cancer

Ramona Dadu, MD, assistant professor, Department of Endocrine Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, discusses the results of a pilot study that examined the efficacy of 

for reducing medullary thyroid cancer (MTC)- related diarrhea.

MTC-related diarrhea can reduce patients’ quality of life. While there are other drugs on the market that can be used to treat MTC-related diarrhea, they generally cause side effects. CASAD is all natural and used to treat diarrhea-related side effects in other cancer patients.

Dadu says 8 out of 9 patients discontinued the current anti-diarrhea medication they were taking after taking CASAD. Also, 7 out of 10 patients were evaluable for the primary endpoint and 4 out of 7 patients met the primary endpoint of reducing the severity of diarrhea.

The best results were seen in between 3 days and 21 days, Dadu says. Every patient on the study responded, with between a 9% and 99% reduction in their frequency of bowel movements. All patients also reported a significant improvement in their quality of life after taking CASAD, Dadu says.

View more from the 2014 ATA Annual Meeting

Ramona Dadu, MD, from the MD Anderson Cancer Center, discusses the results of a pilot study that examined the efficacy of CASAD, a natural clay, to reduce medullary thyroid cancer-related diarrhea.

Ramona Dadu, MD

Articles

Dr. Dadu on Treatment Options for Thyroid Cancer

Dr. Dadu on Immunotherapy in Thyroid Cancer

Dr. Dadu on Treatment Approaches in Medullary Thyroid Cancer

Dr. Dadu on Current Treatment Approaches in Anaplastic Thyroid Cancer

Dr. Dadu on Reducing MTC-Related Diarrhea With CASAD