We review the results from the phase 2 nonrandomized clinical trial on the clinical activity of dual immune checkpoint inhibition in aggressive thyroid cancer. The purpose of the study was to evaluate the efficacy of anti-programmed cell death 1 nivolumab and anti-cytotoxic lymphocyte-associated protein 4 ipilimumab in patients with aggressive thyroid carcinoma. The study presents significant findings on the promising role of dual immunotherapy in treating anaplastic thyroid cancer (ATC) and other aggressive thyroid cancers.

Dual Immunotherapy

The article discusses a phase 2 trial (NCT03246958) that evaluated the efficacy of dual immune checkpoint inhibition using nivolumab (Opdivo) and ipilimumab (Yervoy) in patients with aggressive thyroid cancers. This approach focuses on enhancing the immune system’s ability to target cancer cells effectively.

Efficacy in ATC

For patients with anaplastic thyroid cancer (ATC), the trial showed a promising response. Out of 10 patients with ATC, there was a notable 30% objective response rate (ORR; 95% CI, 6.7%-65.2%), and 50% of the patients demonstrated a clinical benefit. These results highlight the potential of dual immunotherapy in improving outcomes for those affected by this aggressive cancer subtype.

Comparison with Other Thyroid Cancers

In contrast, the same dual immunotherapy regimen showed limited benefit for patients with radioiodine refractory differentiated thyroid carcinoma (RAIR DTC). Only 9.4% of the 32 patients with RAIR DTC had an objective response, all of which were partial responses, indicating a need for different therapeutic strategies.

Medullary Thyroid Carcinoma (MTC)

Among the exploratory cohort of patients with medullary thyroid carcinoma (MTC), researchers reported no responses to the treatments. These results underscore the variability in the response to dual immunotherapy across different thyroid cancer types.

Biomarker Analysis

The analysis linked the presence of NRAS tumor genetic sequence variations to worse outcomes in terms of response to therapy. However, the study found that BRAF V600E mutations did not influence the treatment response, highlighting the complexity of biomarker roles in treatment efficacy.

Implications

The study suggests dual immunotherapy with nivolumab and ipilimumab may benefit some ATC patients. The trial’s small sample size limits conclusions. Further research is needed due to limited ATC treatment options.

Different thyroid cancer types show varying responses, requiring personalized strategies based on cancer subtype and genetic profile. These factors significantly influence outcomes.

Overall, immunotherapy, especially dual immunotherapy, shows promise for anaplastic thyroid cancer, which is hard to treat traditionally.

The evolving landscape of treatment strategies underscores the importance of targeted approaches in managing aggressive forms of cancer. Additional coverage can be read here.