Thyroid cancer research
This page of the thyroid cancer section is about research into the causes, prevention and treatments of thyroid cancer. You can find the following information
Thyroid cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know they are safe.
First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe are they tested in people, in clinical trials. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.
Researchers are looking into
- Diagnosing thyroid cancer
- Finding out about thyroid cancer genes
- Blocking the blood supply to cancer cells that have spread to the liver (chemoembolisation)
- Biological therapies
You can view and print the quick guides for all the pages in the treating thyroid cancer section.
All potential new treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
- We can be sure they work
- We can be sure they work better than the treatments available at the moment
- We know they are safe
First of all, possible new treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS. Cancer Research UK supports a lot of UK laboratory research into cancer.
Tests in patients are called clinical trials. Cancer Research UK supports many UK and international clinical trials.
Our trials and research section has information about what trials are, including information about the 4 phases of clinical trials. Early research in patients is usually restricted to people who have had all other possible treatments.
If you are interested in taking part in a clinical trial for thyroid cancer, go to our clinical trials database. If there is an open trial you are interested in, you can print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.
Thyroid cancer is a relatively rare cancer. So there are not as many trials going on as there are for other more common types of cancer. It is difficult to organise trials when there are fewer patients and it can take longer for the trials to recruit enough people.
Here is a video on experiences of taking part in a clinical trial:
View a transcript of the video (Opens in a new window)
All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for cancer of the thyroid. We don't know yet if they work or whether they work better than treatments available at the moment.
One research study is looking at using different types of MRI scans to see if they are more accurate at diagnosing thyroid cancer. Doctors in this study are using diffusion weighted MRI (DWI) scans that help to show up damaged tissue. They are also using magnetic resonance spectroscopy (MRS) scans that look at chemical changes linked to disease in body tissues.
Another research study is looking at using protein and gene information to develop a test to diagnose thyroid cancer. It is trying to find new ways of diagnosing cancer from blood samples. Both these studies have closed and we are waiting for the results.
A few people are born with a higher risk of thyroid cancer than the general population because they have inherited a high risk faulty gene. Scientists have discovered the faulty gene responsible for some cases of a rare type of thyroid cancer called medullary thyroid cancer (MTC). It is now possible to identify family members who have this abnormal gene and try to stop cancer developing by removing the thyroid gland. Scientists can now find out which part of the gene is faulty. From this they can tell how high a person's risk is of developing thyroid cancer and recommend at what age to remove their thyroid gland. In people at highest risk, this could be before the child is 6 months old.
Most cases of thyroid cancer are not caused by a faulty inherited gene. Most are sporadic, which means they are caused by gene changes (mutations) that happen during a person's lifetime. Scientists are studying the DNA changes that play a part in the development of these cancers. They have already had some success in finding abnormal genes associated with papillary thyroid cancer.
Researchers for the TCUK IN study have collected over 2,000 blood samples from people with thyroid cancer to try to identify genes that increase the risk of developing the disease.
Certain gene changes in thyroid cancer cells may give doctors an idea of how the cancer is likely to behave. They may also show whether it is likely to respond well to a particular treatment, such as biological therapies. Some studies have shown that papillary thyroid cancers with a change in the BRAF gene are more likely to spread or come back (recur). Knowing if a tumour has a BRAF mutation may help doctors to make treatment decisions in the future. For example, it may help them to know whether someone with a very small thyroid cancer (low risk disease) needs to have all of their thyroid gland taken out or just part. Or if the person needs radioactive iodine treatment after surgery or not. However, more research is needed in this area.
Doctors continue to study different combinations of chemotherapy drugs, different doses, and different ways of giving the drugs. The aim of this type of research is to find better ways of treating thyroid cancer with chemotherapy. Generally, doctors don’t use chemotherapy all that much to treat thyroid cancer. Most types respond better to surgery or radiotherapy. But there has been some research looking into treating anaplastic thyroid cancer with different types of chemo. The drugs include cisplatin, doxorubicin and paclitaxel. You can click on the links to find out about the particular side effects of these drugs.
Two large research trials have suggested that a low dose of radioactive iodine may be as good as the higher dose that is currently used to kill off any thyroid cancer cells left after surgery. On the HiLo trial, people who had their thyroid removed (thyroidectomy) for papillary thyroid cancer or follicular thyroid cancer were given a high or a low dose of radioactive iodine. The researchers found that the low dose worked as well as the high dose. Giving a lower dose will help to make sure that people having this treatment are not exposed to any more radiation than necessary.
People who have had their thyroid removed due to thyroid cancer have to take thyroid hormone tablets every day. This is to make up for the loss of their thyroid gland and also to stop their bodies from making thyroid stimulating hormone (TSH), which could encourage thyroid cancer to grow.
Some people have to stop taking thyroid hormone tablets for up to 2 weeks before they have radioactive iodine treatment. This is called thyroid withdrawal. It makes the level of TSH in the blood go up. High TSH levels encourage the thyroid cancer cells to take up more of the radioactive iodine. Stopping thyroid hormone tablets can be quite unpleasant for some people. They feel exhausted and low in energy. An injection called recombinant human thyroid stimulating hormone (rhTSH) is now available. People who have this injection before radioactive iodine treatment don’t have to stop taking their thyroid hormones. So they don't have the effects of low hormone levels.
The HiLo trial looked at whether rhTSH might make radioactive iodine work less well and found that it didn't. But there can be disadvantages to having rhTSH. You have it as an injection into a muscle and need to go to the hospital for the injections. So some doctors prefer to use thyroid withdrawal and monitor thyroid levels so that they can give the radioactive iodine before thyroid hormone levels get low enough to cause unpleasant symptoms.
The IoN trial is looking at whether radioactive treatment is needed for low risk thyroid cancer (papillary or follicular thyroid cancer). If you have had your thyroid gland removed, and your cancer has not spread outside your thyroid gland, it is very unlikely that any cancer cells are left after surgery. So doctors want to find out if radioactive treatment is really needed in this situation.
Researchers are looking into newer ways of giving external radiotherapy for thyroid cancer called IMRT. This stands for intensity modulated radiotherapy. It is a type of conformal radiotherapy. During IMRT, the radiotherapy beam and the dose within the beam are shaped to match the size and thickness of the tumour. Giving radiotherapy in this way means that the radiotherapy beam includes smaller amounts of healthy tissue so you may have fewer or milder side effects.
Researchers for the IMRT trial are trying to find the safest and best dose of IMRT for advanced thyroid cancer. The study has closed and we are waiting for the results.
Before you start radiotherapy, the doctors plan it carefully to make sure the radiotherapy is treating the area where the cancer is. To do this you have a planning CT scan. A study called the THRIFT study is looking at another type of scan called a PET-CT scan to plan radiotherapy for thyroid cancer. The aim of this study is to find out if it is possible to use PET-CT scan for people with thyroid cancer.
Medullary thyroid cancer can spread to the liver. If this happens, it may be possible to use a procedure called chemoembolisation to treat the cancer cells in the liver. The doctor passes a thin tube into an artery in your groin, and then on to the liver. Once the tube is in the right place, the doctor injects chemotherapy straight into the blood vessels supplying the tumour. They also inject a manmade material called an embolic agent that blocks the blood supply to the cancer. This makes the chemotherapy stay in the area of the cancer for longer.
Chemoembolisation attacks the cancer in 2 ways. It gives a concentrated dose of chemotherapy to the area. It also stops the tumour's supply of blood and nutrients. This makes the chemotherapy stay in the area of the cancer for longer. There is detailed information about chemoembolisation in the section about liver cancer.
Biological therapies are treatments that act on processes in cancer cells or that change the way cells signal to each other. They can attack or control the growth of cancer cells. There are different types of biological therapy and research is going on into the following types.
Researchers have been looking at a group of cancer growth blocker drugs called tyrosine kinase inhibitors (TKI). The phase 3 ZETA trial looked at a TKI called vandetanib (Caprelsa). It compared it to a dummy drug (placebo) for people with advanced medullary thyroid cancer. Early results showed that the people who took vandetanib had a longer time before their cancer started to grow again. But it was too early for the researchers to know if the people who took vandetanib lived for longer overall (overall survival). Vandetanib has recently been licensed in the UK for people with advanced medullary thyroid cancer that is causing symptoms and cannot be operated on.
Sorafenib is another type of TKI that researchers have been looking at in trials for thyroid cancer. As well as stopping signals that tell cancer cells to grow, sorafenib also stops cancer cells forming new blood vessels which they need to keep growing. Phase 2 trials have shown promising results for advanced thyroid cancer. An international phase 3 trial looked at sorafenib for advanced papillary and follicular thyroid cancer when radioactive iodine is no longer working. The results have shown that it took longer for the cancer to start growing again in the group of people who took sorafenib compared to placebo.
Pazopanib (Votrient) is another type of TKI. A small trial in the USA found that pazopanib seemed to be able to control differentiated thyroid cancer that had spread. Another trial in the USA found that pazopanib helped some people with medullary thyroid cancer that had spread.
The EXAM trial found that a TKI called cabozantinib was helpful for medullary thyroid cancer that had spread. Cabozantinib works by blocking growth factors and proteins that tell cancer cells to divide. It also stops tumours growing their own blood vessels. The trial team found that it took longer before the cancer started to grow again in the group who had cabozantinib compared to placebo. But it was too early to know if the people who took cabozantinib lived for longer overall. You can read the results of the EXAM trial on our website. Cabozantinib is now licensed in the UK for people with advanced medullary thyroid cancer that continues to grow and cannot be operated on.
Other TKIs being looked at in early trials for thyroid cancer include
- Motesanib phosphate
Cancers need to grow their own blood vessels as they get bigger. This is called angiogenesis. Without its own blood supply, a cancer cannot continue to grow. Some drugs can block cancers from developing new blood vessels and are called angiogenesis inhibitors.
From laboratory studies, we know that thyroid cancers have a richer blood supply than normal thyroid tissue. So this type of cancer may respond to treatment that blocks the development of blood vessels (anti angiogenesis).
Types of angiogenesis inhibitors being looked at in trials for thyroid cancer, on their own or with other treatment, include
Monoclonal antibodies find and attach to particular proteins on cancer cells. The idea is that the antibodies seek out and attack cancer cells. Sometimes monoclonal antibodies are attached to chemotherapy drugs or radioactive molecules so that the anti cancer treatment can go straight to the cancer cells. Scientists have looked into these treatments for thyroid cancer, but we are not aware of any trials for patients in the UK yet.
In Europe, some research has looked at using monoclonal antibodies to find medullary thyroid cancer (MTC) cells that have spread. This type of cancer makes a protein called carcinoembryonic antigen (CEA). Researchers took a monoclonal antibody that could find cells that make CEA. Then they attached a small radioactive label to this antibody. They wanted to see if using the radio labelled antibody in a scan would help them find areas of cancer cells too small to show on other types of scan. The idea is to use the scan to pinpoint cancer spread and then operate to remove it. They have only tested this technique in a few patients, so we don’t really know how useful it is yet.
Sometimes radioactive CEA can be used to treat medullary thyroid cancer that has spread. It can shrink the cancer and reduce symptoms for some people.
Some thyroid cancers produce large amounts of a substance called PDL-1. If your cancer produces a large amount of PDL-1, it is described as being PDL-1 positive. There is a trial looking at a new drug called MK3475 (also known as pembrolizumab) for certain types of advanced cancer. People with advanced papillary or follicular thyroid cancer that is PDL-1 positive might be able to take part in the trial. MK3475 works by stopping 2 substances called PD1 and PDL-1 working together. If these substances can’t work together, cells in the immune system are able to attack cancer cells. Read about pembrolizumab (Keytruda).
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