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Invited Commentary
December 16, 2021

Treatment for Advanced and Metastatic Thyroid Cancer Refractory to Standard Treatment—We Need to Know the When, What, and Who

Author Affiliations
  • 1Endocrine Oncology Branch, Stanford University School of Medicine, Stanford, California
JAMA Oncol. 2022;8(2):250-251. doi:10.1001/jamaoncol.2021.6247

In the past decade, there have been a significant number of new therapeutic alternatives approved by the US Food and Drug Administration for progressive locally advanced and metastatic thyroid cancers of follicular cell origin that are refractory to standard therapy (surgical removal, thyroid hormone for thyroid-stimulating hormone suppression, and radioactive iodine ablation).1-6 These new agents are in 2 categories of compounds: angiogenesis inhibitors (cabozantinib, lenvatinib, and sorafenib) and driver mutation-targeting agents (vandetanib, pralsetinib, trametinib, selpercatinib, and dabrafenib). The approval of the angiogenesis inhibitors was based on level I evidence showing prolonged progression-free survival (PFS) compared with placebo agents as the primary outcome measure.1-3

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1 Comment for this article
Inappropriate control drug
Sok-Ja Janket, DMD, MPH | The Forsyth Institute
It is unfortunate that these researchers did not give any comparable treatment to the control group. In our institution, IRB will reject research proposal unless we use comparable treatment. It is highly unethical to give placebo (non- treatment) to cancer patients. These results should be labeled "biased" and withdrawn. The editorial noted that "The study findings suggest that apatinib may be an alternative to other currently used angiogenesis inhibitors in patients" and this is also wrong. If the editorial would suggest apatinib's superiority over currently used angiogenesis inhibitor, the control group should have been one of those currently used angiogenesis inhibitor.