Thyroid cancer research

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.

Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials. Early research using patients is usually restricted to people who have had all other possible treatments.

If you are interested in taking part in a clinical trial, go to our clinical trials database. Choose 'thyroid' from the dropdown list of cancer types. If there is a 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.

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 just don't know 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 gland 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. 

You can find out about these and other trials on our clinical trials database. Pick 'thyroid' from the dropdown list of cancer types.

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 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. The TCUK IN study is finding out more about genes that may increase thyroid cancer risk. The researchers are looking at the genes of people who have thyroid growths (adenomas) or thyroid cancer to try to find common gene faults. They will also try to find out if any of their relatives have also had thyroid cancer.

In future, this work could lead to gene therapy for thyroid cancer. But at the moment, there are no gene therapy trials for patients with thyroid cancer that we know about in the UK. There is more about gene therapy in the CancerHelp UK section about cancer treatment.

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 more effective 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, including drugs called cisplatin, doxorubicin and paclitaxel. You can click on the links to find out 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. It 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 now looking to see if radioactive treatment is necessary 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 know if radioactive treatment is really needed in this situation.

Researchers are looking into a new way 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 affects smaller amounts of healthy tissue so you may have fewer or milder side effects. IMRT should now be available in every cancer network in England.

The IMRT trial is trying to find the safest and best dose of IMRT for advanced thyroid cancer. The trial is now closed and we are waiting for the results.

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. Then the blood supply to the cancer is blocked off (embolised). 

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.

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. They are part of a group of drugs known as biological therapies.  

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). But it is still early days and so far these treatments haven’t turned out to be quite as promising as we’d hoped. A trial in the UK is looking into using an anti angiogenesis inhibitor called Axitinib (AG-013736) for thyroid cancer that has spread beyond the thyroid gland.

Studies are also looking into other biological therapies such as sorafenib (Nexavar) for advanced thyroid cancer.

Monoclonal antibodies are a type of biological therapy. They can 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 this 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 be seen 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 types of biological therapy block the substances cells use to signal to one another to grow. They are being tested for some types of thyroid cancer. There are different types of cancer growth blocker. 

Pazopanib is a type of cancer growth blocker called a tyrosine kinase inhibitor (TKI). A small trial in the USA found that pazopanib seemed to be able to control differentiated thyroid cancer that had spread. Larger trials in the USA are now looking at how well pazopanib can work for other types of thyroid cancer.

The EXAM trial is looking at a new drug called XL184 for medullary thyroid cancer that has spread outside the thyroid gland and can't be removed with surgery. XL184 is also known as cabozantinib (Exelixis). It works by blocking growth factors and proteins that tell cancer cells to divide. It also stops tumours growing their own blood vessels. Researchers want to see if XL184 slows down the growth of medullary thyroid cancer. In this trial, they are comparing it with a dummy drug (placebo). The trial has closed and we are waiting for results.

Researchers have been looking at a new type of cancer growth blocker called vandetanib. The early results of an international trial which compared it with a placebo found that vandetanib helped people have a longer time before their cancer grew. The trial was for people with advanced medullary thyroid cancer. It is too early to say whether it will help people live longer but the researchers will continue to follow the people who took part in the trial.