Types of Thyroid Cancer Drugs Available
There are several types of drugs available for treating different types of thyroid cancer. Surgery to remove all or part of the thyroid gland is usually the first line of treatment, followed by administration of drugs. Some of the major classes of thyroid cancer drugs include:
- Targeted kinase inhibitors: These Thyroid Cancer Drugs, target proteins called kinases that help cancer cells thrive and multiply uncontrollably. Drugs like lenvatinib (Lenvima), sorafenib (Nexavar), cabozantinib (Cabometyx), vandetanib (Caprelsa) and pazopanib (Votrient) are FDA approved kinase inhibitors for treating certain types of thyroid cancer.
- Chemotherapy drugs: For advanced cases where cancer has spread beyond the thyroid gland, chemotherapy may be administered. Common chemo Thyroid Cancer Drugs Research include doxorubicin, cisplatin and carboplatin. However, thyroid cancer is often resistant to chemotherapy.
- Radioactive iodine therapy: This treatment utilizes a radioactive form of the element iodine, which thyroid cells readily absorb. It is most effective against differentiated thyroid cancer that retains the ability to take up iodine. Drugs like levothyroxine are given before treatment to stimulate iodine absorption.
Role of Targeted Kinase Inhibitors
Targeted kinase inhibitors are becoming the standard of care for advanced and radioactive iodine-resistant thyroid cancers. They work by blocking specific kinases that drive the growth and spread of cancer cells. Lenvatinib was the first drug to be approved by the FDA for radioactive iodine-refractory differentiated thyroid cancer in 2015 based on its ability to prolong progression-free survival compared to placebo.
Sorafenib gained approval for metastatic, radioactive iodine-resistant thyroid cancer in 2013. It showed a 10-month improvement in PFS versus placebo. Cabozantinib received approval for locally advanced or metastatic medullary thyroid cancer in 2012. It doubled the PFS compared to placebo. Vandetanib and pazopanib are also being prescribed off-label for advanced thyroid cancers. However, these drugs often cause side effects due to inhibiting other normal cell functions as well.
Ongoing Research and New Drug Development
Research into improved targeted therapies for thyroid cancer is ongoing. Combination therapies using two or more targeted drugs together hold promise. A phase III trial is studying cabozantinib in combination with lenvatinib and found it improved PFS significantly over individual drugs. Trials are also examining immunotherapy drugs, either alone or in combination with targeted drugs or chemotherapy for refractory thyroid cancers.
New drugs like selpercatinib, which selectively inhibits the RET gene mutation driving some thyroid cancers, received an accelerated FDA approval in 2020. Investigational drugs like LOXO-292 that target multiple kinases driving cancer growth are showing promise in early trials. BIVV003, a bispecific antibody targeting proteins on thyroid cancer and immune cells, is in phase I/II testing. Scientists are optimistic these novel therapies may help advanced thyroid cancer manageable as a chronic disease like other cancers.
Coverage and Access Issues
While targeted therapies have improved treatment options for advanced thyroid cancers, their high cost poses challenges for patients and payers. The annual costs of these drugs range from $100,000 to $250,000 and they offer only modest increases in PFS. Insurance companies often require extensive documentation to approve the drugs or limit the duration of approval due to lack of long-term survival data.
Patient assistance programs run by drugmakers help with coverage gaps and copays. Medical necessity appeals where an endocrinologist details the individual benefits are sometimes successful. Thyroid cancer advocacy groups also help guide patients through the process. As research continues to establish these drugs' overall value based on improving quality of life, access and coverage is expected to become more widespread over time. Thyroid cancer treatment has progressed tremendously in recent years due to the advent of molecularly targeted drugs. These therapies have added valuable time before disease progression occurs in advanced cases previously with limited options. Ongoing clinical trials are exploring improved targeted agents alone or in combination as well as immunotherapies. As research helps establish more long-term outcomes, the cost-effectiveness profile is also anticipated to expand insurance coverage for patients. Overall, newer drugs are transforming thyroid cancer into a more manageable chronic condition.
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