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NCCN Issues Updates for Clinical Practice Guidelines for Thyroid Cancer
"The increasing incidence of thyroid carcinoma is a worldwide phenomenon," stated Dr. Sherman as he outlined major updates to the NCCN Guidelines.
A notable addition to the NCCN Guidelines is a recommendation to consider commercially available, small molecule kinase inhibitors such as sorafenib (Nexavar(R), Bayer) or sunitinib (Sutent(R), Pfizer, Inc.) in the treatment of metastatic papillary carcinoma, follicular carcinoma, Hurthle cell carcinoma, or medullary carcinoma.
"Our primary recommendation for these patients is to investigate a clinical trial, but if one is not available or appropriate; data from clinical trials have shown that small molecule kinase inhibitors such as sorafenib and sunitinib can be effective," said Dr. Sherman.
Also new to the NCCN Guidelines is a page, Principles of Thyroid Stimulating Hormone (TSH) Suppression that provides recommendations for levothyroxine use for TSH Suppression throughout the Papillary, Follicular and Hurthle Cell Guidelines.
"Given the potential toxicities associated with TSH Suppression therapy that can have an effect on bone and heart health, it is best to use this therapy in a limited capacity," noted Sherman. "The new page in the NCCN Guidelines states that patients should be treated with the most conservative dose of hormone suppression therapy based on their level of disease plan. In addition, for those patients with recurrent thyroid carcinoma being administered TSH therapy, the NCCN Guidelines recommend decreasing the dose over time and encouraging adequate intake of calcium and vitamin D to prevent osteoporosis."
In addition, the procedures for evaluating thyroid nodules have been revised in the updated NCCN Guidelines particularly those for follicular or Hurthle cell neoplasms or for follicular lesions of undetermined significance, which cannot be diagnosed by fine needle aspiration (FNA). The diagnostic categories for FNA results have been revised in the new NCCN Guidelines and reflect recent data from the National Cancer Institute State of the Science Conference.
Dr. Sherman stressed the importance of evaluating suspicious nodules saying that, "ultrasound continues to be the single most useful imaging tool to diagnose palpable thyroid masses, however; there are no diagnostic features of a nodule that is benign."
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.
Source: National Comprehensive Cancer Network