Title: Cabozantinib for previously treated differentiated thyroid cancer unsuitable for or refractory to radioactive iodine [ID4046]
Funder: Department of Health and Social Care

Abstract: Thyroid cancer is a rare type of cancer that affects the thyroid gland, a gland at the base of the neck that produces hormones. Thyroid cancers can be differentiated or undifferentiated. Differentiated thyroid cancer cells retain the appearance of normal thyroid cells and do not spread as quickly as undifferentiated cancer cells. There are 4 main types of thyroid cancer: papillary, follicular, medullary and anaplastic. Papillary and follicular carcinomas are differentiated thyroid cancers and the most common types of thyroid cancer, with similar management and prognosis. There are also several less common variants of differentiated thyroid cancer, including but not limited to Hürthle cell, tall cell, insular, and columnar. _x000D_ _x000D_ Thyroid cancer is uncommon and accounted for 1.2% of all new cases of cancer in the UK in 2020.[1] There was a 5-year prevalence of 21,306 people with thyroid cancer in the UK in 2020.[1] Differentiated thyroid cancers are the most common types of thyroid cancers, with papillary carcinomas responsible for 80 to 90% of cases. [2],[3] Follicular carcinomas account for approximately 10% of cases.[2] Differentiated thyroid cancers are typically curable, 10-year survival is typically around 85%.[4] Survival for thyroid cancer is strongly related to stage of disease. Survival is highest for adults diagnosed when the cancer is localised to the thyroid (Stage 1 to Stage 3), with 1-year age-standardised survival of around 99%. Once the cancer has spread beyond the thyroid (Stage 4) 1-year age-standardised survival for adults diagnosed is 77%.[5] _x000D_ _x000D_ Thyroid cancer is usually treated by partial or total thyroidectomy. The choice of surgery depends on the type and size of cancer amongst other factors. Surgery may be followed by adjuvant treatments. Primarily, this is radioactive iodine which is used to destroy any residual thyroid tissue and any remaining cancer cells. External beam radiotherapy or palliative chemotherapy can also be used. The British Thyroid Association’s ‘Guidelines for the management of thyroid cancer’ notes that the use of external beam radiotherapy and chemotherapy in palliative care has begun to be superseded by targeted therapy.[6] In clinical practice, best supportive care or monitoring is offered until the disease starts to progress and symptoms occur, or there is rapid progression that is likely to become symptomatic. For residual or recurrent disease targeted therapy (tyrosine kinase inhibitors) may be used. NICE technology appraisal 535 recommends lenvatinib and sorafenib, which inhibit multiple receptor tyrosine kinases including vascular endothelial growth factor (VEGF) receptors, as options for treating differentiated thyroid cancer after radioactive iodine. NICE technology appraisal 742 recommends selpercatinib for use within the Cancer Drugs Fund as an option for treating advanced RET fusion-positive thyroid cancer. NICE technology appraisal 630 recommends larotrectinib for use within the Cancer Drugs Fund as an option for treating for treating NTRK fusion-positive solid tumours._x000D_ _x000D_ References_x000D_ 1. International Agency for Research on Cancer (2021) United Kingdom. Accessed March 2022._x000D_ 2. NHS conditions (2019) Thyroid cancer. Accessed March 2022._x000D_ 3. Cancer Research UK (2021) Types of thyroid cancer. Accessed May 2022._x000D_ 4. Dal Maso L, Tavilla A, Pacini F et al. (2017) Survival of 86,690 patients with thyroid cancer: A population-based study in 29 European countries from EUROCARE-5. European Journal of Cancer 1;77:140-152._x000D_ 5. Office for National Statistics (2019) Cancer survival in England – adults diagnosed. Accessed March 2022._x000D_ 6. Perros P, Colley S, Boelaert K et al. (2014) Guidelines for the management of thyroid cancer. Clinical Endocrinology: 81;s1.

Lay abstract: To appraise the clinical and cost effectiveness of cabozantinib within its marketing authorisation for treating locally advanced or metastatic differentiated thyroid cancer, in adults whose disease is refractory to, or who are unsuitable for, radioactive iodine and whose disease has progressed during or after prior systemic therapy.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS