On National Thyroid Cancer Day, September 28, patients are calling on health authorities for public funding of new generation drugs that have proven effective against the most aggressive types of this tumor.
The Spanish Thyroid Cancer Association (AECAT) regrets that these treatments have the green light from the Spanish Medicines and Health Products Agency (AEMPS) but are not included in public funding.
On the occasion of this National Day, this patient association is launching the campaign “In thyroid cancer, not a step back” to raise awareness of a rare disease of which around 5,000 cases are diagnosed a year, mainly in women.
“Thyroid cancer has a high survival rate, between 95 and 98%, but unfortunately there are forms that are more aggressive and that do not have effective treatments. The worst of all is that some treatments indicated for this type of cancer are not financed by the public health system”, explains her president, Arantxa Sáezalso thyroid cancer patient.
“We are lucky that the research is progressing and that new alternatives are being developed for these more complicated cases, but then we don’t get there”, he regrets.
A la carte treatments for thyroid cancer
Patients are demanding access to personalized precision medicine: “It would represent a major advance in health care and would favor more effective and safer preventive, diagnostic and therapeutic medical interventions, adapted to the characteristics of patients”, says the president of AECAT.
In addition, he points out, it would avoid unnecessary expenses that would contribute to the sustainability of healthcare systems, and most importantly, it would offer the patient a personalized therapeutic alternative that avoids therapeutic failures, unnecessary side effects and reduces the time to access the correct treatment.
For this reason, “carrying out genetic sequencing in thyroid cancer can help many patients who, without it, will have to try different therapies that will have an impact on the quality of life, in addition to the emotional wear and tear caused by the failure of a therapeutic strategy”.
From clinical practice, the doctor Jaume Capdevila, from the Oncology Service of the Vall d’Hebron Hospital in Barcelonaexplains: “In recent years we are seeing a development of personalized therapy in oncology that has never been seen before, with the arrival of drugs that are able to block a specific alteration in the tumor so selectively that they produce great responses with a very good safety profile”.
However, “these drugs sometimes do not follow the classic steps of clinical oncology research, since the molecular alterations to which they are directed are relatively infrequent and it is impossible to design a phase III clinical study like the ones we are used to seeing” .
However, “the selection of patients to be treated based on the tumor’s genomic alteration allows us to observe results that go beyond the limitations of the tumor histological type and achieve benefit in any type of tumor that presents this specific alteration”, he says.
According to the oncologist, thyroid cancer “in all histological aspects, has always been a paradigm for the development of targeted therapies, as it presents mutations and gene fusions for which we have targeted drugs”.
For some histological subtypes of thyroid cancer, he points out, “we will have the possibility to carry out classic phase III studies that will allow us to create the scientific evidence we are used to, but in other histological types of thyroid cancer, this will be completely impossible for the simple matter of the incidence of the disease, therefore, we will have to rely on the tumor agnostic indication to be able to offer the treatment to all patients who can benefit”.
“These approvals based on genomic alteration regardless of tumor type, known as tumor agnostic, are already being achieved in both Europe and the United States, and affect patients with both differentiated, medullary and anaplastic thyroid cancer, involving genes as relevant as BRAF, RET or NTRK”.
Therefore, for this specialist, “the Spanish authorities must understand what these advances mean, the specific type of pharmacological development they need based on these biomarkers, and in the end allow their use without purely economic restrictions, since the clinical effectiveness is more than clear”.
Treatment and quality of life
Control of thyroid cancer treatments can affect quality of life, as sometimes symptoms attributed to stress or fatigue are actually caused by poor control of hormone levels.
The doctor Pablo Valderrábano, specialist in endocrinology at the Ramón y Cajal University Hospital of Madrid, explains the need to “maintain a very long-term or even lifelong follow-up.”
“Usually after the initial treatment of thyroid cancer, it is necessary to start treatment with thyroid hormone which must be adjusted to the weight and metabolism of each patient and also to the type of cancer and the estimated probability that the cancer will reappear”, he indicates.
The endocrinologist acknowledges that “in all cases, it is necessary to carry out a periodic check to verify that the dose taken by the patient is appropriate for his specific case”.
“This analysis must be done at least once a year, along with the tumor markers. In addition, it is necessary to look at it beforehand in case you want to look for a pregnancy, since during pregnancy it is usually necessary to increase the dose of thyroid hormone”, explains the doctor.
The president of AECAT concludes: “We can improve all this with access to innovative drugs and with a therapeutic plan adapted to your type of tumor, this is genetic diagnosis… Planning how you will treat this cancer and offering it the best adapt to the case Stop trying options, stop wasting resources, stop wasting time. Stopping health decline”.