title: New therapeutic options for advanced forms of thyroid cancer.
abstract: BACKGROUND
  While the vast majority of patients with thyroid cancer have an excellent prognosis, those with more aggressive courses experience significant morbidity and mortality. Advanced forms of thyroid cancer are typically refractory to standard therapy. Numerous agents with potential usefulness in the treatment of advanced thyroid cancer have recently come under study.
  
  
  METHODS
  This article reviews agents identified through a systematic review of the scientific literature as being under investigation for treatment of advanced thyroid cancer. A search of both PubMed and the NCI Clinical Trials website was performed to identify such agents having reached Phase II or III testing. Improved understanding of cancer cell signaling pathways has led to the identification of > 500 kinases as potential therapeutic targets. Additional agents of interest include those that inhibit neoangiogenesis, alter epigenetic factors or stimulate antitumor immune reactions. While presently available agents have shown promise in improving progression-free survival (PFS), complete responses are not seen and significant adverse side effects are encountered.
  
  
  CONCLUSIONS
  The development of numerous new anticancer agents holds the promise of treatment regimens that will extend PFS and ultimately overall survival in patients with advanced thyroid cancer. Anticipated future developments include individualized, multimodal treatment regimens based on specific tumor cell biology and driver mutations.
authors.affiliation: Medicine/Endocrinology, Mayo Clinic , 4500 San Pablo Road, Jacksonville, FL 32082 , USA bernet.victor@mayo.edu.
authors.forename: Victor
authors.initials: V
authors.lastname: Bernet
authors.forename: Robert
authors.initials: R
authors.lastname: Smallridge
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018278:Carcinoma, Neuroendocrine; D018572:Disease-Free Survival; D006801:Humans; D057285:Precision Medicine; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D065646:Thyroid Carcinoma, Anaplastic / Q000188:drug therapy; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: anaplastic thyroid cancer; anti-CEA antibodies; b-raf inhibitors; differentiated thyroid cancer; histone deacetylase inhibitors; kinase inhibitors; medullary thyroid cancer; thyroid cancer; thyroid cancer therapy