RTP On Demand — Head & Neck/Thyroid | Research To PracticeTreatment algorithm for medullary thyroid cancer
2:55 minutes.
TRANSCRIPTION:
DR COHEN: Medullary’s a little bit different in that the 2 drugs that are approved, in my mind, have some distinct differences, that vandetanib, I do believe, is going to be, in general, better tolerated than cabozantinib. But on the other hand, cabozantinib, again as fair as it is to compare between Phase III trials, the study that garnered approval appears to have enrolled a more aggressive patient population, and yet there’s a wide difference in the progression-free survival suggesting that cabozantinib, again, is quite an effective agent. However, the differences in efficacy if you compare between the 2 studies are less pronounced between vandetanib and cabozantinib. And in general, as I said, vandetanib is going to be a better tolerated drug. So here, I really begin to assess how I think the patient is going to respond in terms of side effects on these agents. And, let’s say, a patient whose performance status is not so good, who may have some other major comorbidities, I’m probably inclined to start them on vandetanib because I think that they’ll probably be able to tolerate that drug a little bit better. A patient whose disease is progressing more rapidly, who has a higher volume of disease, who has a good performance status, I’m more inclined to start on cabozantinib. With one exception, and that is any patient who has any reason to fear for QT prolongation, and that’s because of the black box warning associated with vandetanib, I would avoid that drug completely in those patients. DR LOVE: And what about second-line therapy? DR COHEN: So whatever I don’t use in the first line, I use in the second line. DR LOVE: And what fraction of patients ends up getting both therapies? DR COHEN: Oh, high. I would say probably 80%. DR LOVE: What’s the variation that you see in how long people are on first- and second-line therapy? DR COHEN: So usually patients are on the first line for an average of about a year and maybe even a little bit more than that. So we do get a significant amount of time on that first-line therapy. And then on the second-line therapy, even with that flip, for medullary thyroid cancer patients are on the second drug also for close to a year. Again, in my experience. Maybe a little bit less than that. So between these 2 drugs, on average, we’re probably getting about 2 years of progression-free survival or at least disease control. And for some patients, it’s significantly more than that. |