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Advanced thyroid cancer

Conquest - Summer 2013

The treatment: Early leadership translates into new therapy

Related story: A magnificent seven


By William Fitzgerald

Patients with medullary thyroid cancer had a 40% response rate in a Phase I clinical trial with the drug cabozantinib. This led the U.S. Food and Drug Administration (FDA) to allow researchers to bypass the standard Phase II trial and immediately begin a randomized Phase III trial for this patient population. Now, a clinical trial is investigating how this drug could help those with papillary thyroid carcinoma.

Disease: While medullary disease is a rare subtype that comprises 3% to 4 % of all thyroid cancers, papillary thyroid carcinoma includes about 80% of all thyroid cancers diagnosed in the United States.

Oral medication: Cabozantinib (Cometriq®) was approved under the FDA’s priority review program in 2012, making it the second treatment approved for the medullary subtype in the past two years.

Clinical trial: Researchers are now studying its effects on the papillary subtype, which occurs most commonly in women between the ages of 30 and 50.

“It’s a very exciting compound, and we feel we played an absolutely critical role in identifying the value of cabozantinib and moving it forward,” says Steven Sherman, M.D., professor and chair of the Department of Endocrine Neoplasia and Hormonal Disorders, who was also the senior investigator on the trial with medullary thyroid cancer patients and now working with papillary thyroid patients.

The patient: Optimistic attitude a must

When the results of Mindy Morris’ pathology came back, she was relieved. The needle biopsy confirmed the lump in her neck was not malignant. Three years went by, however, and the mass continued to grow. Surgery was soon scheduled, and when it was finished, the news this time was not good.

Mindy Morris

“The doctors found a lemon-sized tumor, and I was immediately in a high-risk situation,” Morris says. “It turned out to be metastatic papillary thyroid carcinoma. After seven years, five additional surgeries and four rounds of radiation, I was told to get my affairs in order.”

The prognosis came as a complete shock. “How could this be?” Morris recalls thinking after first being told everything would be fine. With cancer now spreading throughout her chest and lungs, the only thought she could keep was what to do next.

That’s when Morris traveled to MD Anderson and enrolled in a clinical trial, evaluating a new drug called cabozantinib. Since she started the therapy in 2010, she’s responded well with some tumors now gone and others shrinking in size. The treatment is not curative at this point, but Morris has learned to maintain an optimistic attitude.

“I feel like one of the lucky ones because I qualified for this trial,” she says. “Ultimately, it’s given me 2 1/2 more years of life that I wouldn’t have had otherwise.”

Morris plans to continue her treatment in hopes the drug will stave off the disease long enough for another promising agent to be developed.

— William Fitzgerald

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