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NCCN Presents Updates to NCCN Guidelines for Thyroid Carcinoma
NCCN presented new updates to the NCCN Clinical Practice Guidelines in Oncology™ for Thyroid Carcinoma at the NCCN 14th Annual Conference on March 14. Notable updates include a new page on Thyroid Stimulating Hormone (TSH) Suppression, the expanded recommendation of small molecule kinase inhibitors, and revised procedures for evaluating thyroid nodules. Steven I. Sherman, MD, of The University of Texas M. D. Anderson Cancer Center and chair of the NCCN Guidelines Panel for Thyroid Carcinoma, presented the new NCCN Guidelines.
March 16, 2009
HOLLYWOOD, FL – The incidence of thyroid carcinoma is increasing faster than any other solid tumor according to Steven I. Sherman, MD, of The University of Texas M. D. Anderson Cancer Center during a recent presentation at the National Comprehensive Cancer Network’s 14th Annual Conference discussing updates to the NCCN Clinical Practice Guidelines in Oncology™ for Thyroid Carcinoma.
“The increasing incidence of thyroid carcinoma is a worldwide phenomenon,” stated Dr. Sherman as he outlined major updates to the NCCN Guidelines.
A notable addition to the NCCN Guidelines is a recommendation to consider commercially available, small molecule kinase inhibitors such as sorafenib (Nexavar®, Bayer) or sunitinib (Sutent®, Pfizer, Inc.) in the treatment of metastatic papillary carcinoma, follicular carcinoma, Hürthle cell carcinoma, or medullary carcinoma.
“Our primary recommendation for these patients is to investigate a clinical trial, but if one is not available or appropriate; data from clinical trials have shown that small molecule kinase inhibitors such as sorafenib and sunitinib can be effective,” said Dr. Sherman.
Also new to the NCCN Guidelines is a page, Principles of Thyroid Stimulating Hormone (TSH) Suppression that provides recommendations for levothyroxine use for TSH Suppression throughout the Papillary, Follicular and Hürthle Cell Guidelines.
“Given the potential toxicities associated with TSH Suppression therapy that can have an effect on bone and heart health, it is best to use this therapy in a limited capacity,” noted Sherman. “The new page in the NCCN Guidelines states that patients should be treated with the most conservative dose of hormone suppression therapy based on their level of disease plan. In addition, for those patients with recurrent thyroid carcinoma being administered TSH therapy, the NCCN Guidelines recommend decreasing the dose over time and encouraging adequate intake of calcium and vitamin D to prevent osteoporosis.”
In addition, the procedures for evaluating thyroid nodules have been revised in the updated NCCN Guidelines particularly those for follicular or Hürthle cell neoplasms or for follicular lesions of undetermined significance, which cannot be diagnosed by fine needle aspiration (FNA). The diagnostic categories for FNA results have been revised in the new NCCN Guidelines and reflect recent data from the National Cancer Institute State of the Science Conference.
Dr. Sherman stressed the importance of evaluating suspicious nodules saying that, “ultrasound continues to be the single most useful imaging tool to diagnose palpable thyroid masses, however; there are no diagnostic features of a nodule that is benign.”