Expert Point of View: Ezra Cohen, MD

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“These patients finally have options,” commented the DECISION trial’s discussant at the ASCO Plenary Session, Ezra Cohen, MD, Associate Professor of Medicine and Associate Director for Education at the University of Chicago Comprehensive Cancer Center. He further noted that differentiated thyroid cancer is a cancer on the rise worldwide. But while Dr. Cohen was enthusiastic about the findings, he noted that not all iodine-refractory patients require treatment.

Interestingly, 25% of placebo recipients did not show disease progression while on study, he said. In addition, other studies show that patients who are negative for positron-emission tomography (PET) avidity have a median overall survival of more than 3 years, and in clinical practice, most radioactive iodine–refractory patients are asymptomatic, he reminded oncologists.

Treatment Decision Factors

“Clearly, there are patients who do not need immediate treatment,” Dr. Cohen emphasized. He would, therefore, base his decision to use sorafenib (Nexavar) on the patient’s symptom burden, and the location and growth rate of anatomic disease, he said. Sorafenib is one of six vascular endothelial growth factor receptor (VEGFR) inhibitors either indicated for or being evaluated in thyroid cancer. While these agents prolong remission, they do not induce complete responses or cure the disease. In fact, patients will inevitably become resistant to these agents.

Therefore, new drugs or combinations continue to be needed, he pointed out. In a phase I/II trial,1 the novel combination of the VEGFR inhibitor cediranib plus lenalidomide (Revlimid) “appears to be quite active, with almost all patients showing some degree of tumor shrinkage,” he noted.

Beyond this type of novel regimen, he predicted that future treatments will involve targeting the distinct molecular phenotypes of the disease, he added. The use of vemurafenib (Zelboraf) in patients with BRAF mutations has looked promising, he noted. ■

Dislcosure: Dr. Cohen receives honoraria from Exelixis, AstraZeneca, and Bayer.


1. National Institutes of Health: Cediranib maleate with or without lenalidomide in treating patients with thyroid cancer. Available at Accessed June 13, 2013.

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