Thyroid cancer: low-dose radioactive iodine works in the long term too

Now we have long-term data from the original HiLo trial. Patients with no distant metastasis, well-differentiated thyroid carcinoma do as well with low-dose radioactive iodine (30 mCi) treatment compared to those receiving the high dose RAI (100 mCi).

Unless distant metastasis is documented, patients with well-differentiated papillary or follicular cancer should receive 30 mCi I-131 when indicated. A group of 450 patients was followed for about 7 years.


New FDA approval: drug therapy for anaplastic thyroid cancer

Anaplastic thyroid cancer (ATC) is a rare and aggressive type of thyroid cancer. It accounts for about 1-2% of all thyroid cancers. NIH estimates 54,000 new cases of thyroid cancer and 2,000 deaths from the disease in the US in 2018. 

The tafinlar + mekinist combination is now approved for the treatment of BRAF V600E mutation-positive ATC that cannot be addressed surgically or has already spread to other organs. Tafinlar and Mekinist have also been approved for two other BRAF V600 mutation-positive metastatic malignancies; melanoma and non-small cell lung cancer.


Cancer immunotherapy causes hypothyroidism

Nivolumab is an effective immunotherapy for advanced malignancies such as gastric cancer, renal cell carcinoma, unresectable metastatic melanoma, non-small cell lung cancer, hodgkin lymphoma and head/neck cancer. However it has also been noted to cause endocrinopathies like type 1 diabetes and pituitary, adrenal and thyroid dysfunctions.

Current study shows that nivolumab-induced inflammatory hypothyroidism is relatively rare at about 5% in 6 months, and was mainly seen in participants with elevated baseline thyroid antibodies. This suggests that the anti-PD1 monoclonal Ab therapy causes hypothyroidism in predisposed individuals, thus initial evaluation of TPO and Tg antibodies may be warranted prior to starting nivolumab.


Diabetes and obesity increase the risk of 12 malignancies

The article provides more evidence that diabetes and obesity increase the risk of malignancy, particularly of colorectal, gallbladder, pancreas, kidney, liver, endometrial, postmenopausal breast, ovarian, gastric cardia, thyroid cancer, esophageal adenocarcinoma and multiple myeloma. It is estimated that 430 million adults have diabetes worldwide, while 2.0 billions are overweight or obese. How could this global health problem be meaningfully approached?


Small thyroid cancers, how to monitor?

Thyroid papillary micro-carcinoma is defined as an isolated cancer with diameter no larger then 1.0 cm. It is considered to have good long-term prognosis. Analyses reveal that these small cancers could be more aggressive than expected. Authors also find that cancer volume, rather than diameter, expansion is the best structural tool in identifying tumors at risk of progression.