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The NCCN Guidelines for Thyroid Carcinoma provide recommendations for the management of different types of thyroid carcinoma, including papillary, follicular, Hürthle cell, medullary, and anaplastic carcinomas. These NCCN Guidelines Insights summarize the panel discussion behind recent updates to the guidelines, including the expanding role of molecular testing for differentiated thyroid carcinoma, implications of the new pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features, and the addition of a new targeted therapy option for BRAF V600E-mutated anaplastic thyroid carcinoma., (Copyright © 2018 by the National Comprehensive Cancer Network.)

Purpose To investigate the risk and outcomes of second hematologic malignancies (SHMs) in a population-based cohort of patients with well-differentiated thyroid cancer (WDTC) treated or not with radioactive iodine (RAI). Methods Patients with WDTC were identified from SEER registries. Competing risk regression analysis was performed to calculate the risks of SHMs that occurred after WDTC treatment and outcomes after SHM development were assessed. Results Of 148,215 patients with WDTC, 53% received surgery alone and 47% received RAI. In total, 783 patients developed an SHM after a median interval of 6.5 years (interquartile range, 3.3 to 11.2 years) from WDTC diagnosis. In multivariable analysis, compared with those undergoing thyroidectomy alone, RAI treatment was associated with an increased early risk of developing acute myeloid leukemia (AML; hazard ratio, 1.79; 95% CI, 1.13 to 2.82; P = .01) and chronic myeloid leukemia (CML; hazard ratio, 3.44; 95% CI, 1.87 to 6.36; P < .001). This increased risk of AML and CML after RAI treatment was seen even in low-risk and intermediate-risk WDTC tumors. Occurrence of AML but not CML in patients with WDTC was associated with shorter median overall survival compared with matched controls (8.0 years v 31.0 years; P = .001). In addition, AML developing after RAI trended toward inferior survival compared with matched controls with de novo AML (median overall survival, 1.2 years v 2.9 years; P = .06). Conclusion Patients with WDTC treated with RAI had an increased early risk of developing AML and CML but no other hematologic malignancies. AML that arises after RAI treatment has a poor prognosis. RAI use in patients with WDTC should be limited to patients with high-risk disease features, and patients with WDTC treated with adjuvant RAI should be monitored for myeloid malignancies as part of cancer surveillance.

Medullary thyroid carcinoma (MTC) is a rare malignancy comprising 1-2% of all thyroid cancers in the United States. Approximately 20% of cases are familial, secondary to a germline RET mutation, while the remaining 80% are sporadic and also harbour a somatic RET mutation in more than half of all cases. Up to 15-20% of patients will present with distant metastatic disease, and retrospective series report a 10-year survival of 10-40% from time of first metastasis. Historically, systemic therapies for metastatic MTC have been limited, and cytotoxic chemotherapy has demonstrated poor objective response rates. However, in the last decade, targeted therapies, particularly multitargeted tyrosine kinase inhibitors (TKIs), have demonstrated prolonged progression-free survival in advanced and progressive MTC. Both cabozantinib and vandetanib have been approved as first-line treatment options in many countries; nevertheless, their use is limited by high toxicity rates and dose reductions are often necessary. New generation TKIs, such as selpercatinib or pralsetinib, that exhibit selective activity against RET, have recently been approved as a second-line treatment option, and they exhibit a more favourable side-effect profile. Peptide receptor radionuclide therapy or immune checkpoint inhibitors may also constitute potential therapeutic options in specific clinical settings. In this review, we aim to present all current therapeutic options available for patients with progressive MTC, as well as new or as yet experimental treatments. [ABSTRACT FROM AUTHOR]

The article details a study which examined if any of the nine polymorphisms in five candidate genes are associated with severe liver disease in patients diagnosed with cystic fibrosis (CF). The study included 124 patients with CF and severe liver disease with portal hypertension (CFLD) from centers in the U.S., Canada and outside of North America and 843 control subjects. The differences in the distribution of genotypes in the study population were analyzed. Study authors found that SERPINA1 Z allele is a risk factor for the development of liver disease in patients with CF.

This study compares tear glucose dynamic differences between 121 diabetic and nondiabetic subjects after the administration of a carbohydrate load. A quantitative chromatographic analysis of tear glucose was used and the values correlated to blood glucose values. Diabetic and nondiabetic tear glucose mean values were 0.35 ± 0.04 mmol/L and 0.16 ± 0.03 mmol/L, respectively. Significant differences were observed among the subject groups in both the tear and capillary blood glucose values. A correlation between tear glucose and capillary blood glucose was observed. The concentration of glucose in the tear fluid changes proportionately with respect to capillary blood glucose after a carbohydrate challenge. Although it is possible to determine the diabetic status of a subject using tear glucose values alone, in the clinical setting this may not prove to be practical due to technical limitations. [ABSTRACT FROM AUTHOR]

There have been significant improvements in cancer treatment in the last few decades. The use of radiation in the treatment of cancer is widespread and has increased. Up to 40% of cancer pts will receive radiotherapy as part of their management. More successful treatment has meant improved survival rates, but conversely patients are living longer and encountering more treatment-induced complications. The development of a second primary malignancy, often many years later, is one of the more sinister complications. The American National Cancer Institute published data in 2006 reporting that ‘Cancer survivors constitute 3.5% of the US population’ but that ‘second malignancies among high risk groups now accounts for 16% of all cancer incidence. The timescale between completion of the radiotherapy and the development of a second malignancy, known as the latent period, can vary widely from as little as 5 years up to 50 years later. In this report we present three cases of radiation-induced second malignancies seen in the Palliative Care setting and then give an overview of radiation induced second malignancies, looking at the aetiology, genetics and the palliative care implications for these patients. [ABSTRACT FROM AUTHOR]