Clinical OMICS

MAR-APR 2017

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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16 Clinical OMICs March/April 2017 Diagnostics Less Is More UPMC Clinical Trial to Examine If More Precise Molecular Profiling of Thyroid Cancer Patients Can Decrease Thyroidectomies By Meghaan Ferreira, Contributing Editor W hen it comes to thyroid cancer, is less more? Research- ers at the University of Pittsburgh Medical Center (UPMC) aim to answer this question with the first-ever pro- spective clinical trial to test whether molecular profiling can enable tailored, thyroid-preserving surgeries instead of total thyroidectomies by preoperatively identifying nonaggres- sive, low-risk thyroid cancer cases . In addition to reducing the risk for surgical complications, removing only half of the thyroid, also referred to as a lobectomy, may leave enough of the butterfly-shaped gland intact to avoid the need for daily hormone replacement therapy . The study will implement ThyroSeq v . 2, one of several molecular profiling tools on the market designed to iden- tify the genomic signatures of thyroid cancer . Initially developed by a scientific team lead by Yuri Nikiforov, M.D., Ph . D . at UPMC, ThyroSeq is currently used to predict the risk of thyroid cancer in a subset of patients, which accounts for approximately 20% of all biopsies, where conventional cytology cannot differentiate between malignant and benign thyroid nodules . The latest version of ThyroSeq uses next-generation sequencing to test fine needle biopsies for the presence of 42 different thyroid cancer-associated mark- ers across 14 genes . "As we become more experienced with these genetic markers, we're getting more information about the biologic behavior and disease characteristics of tumors, and we're seeing genotype-phenotype associations—certain genetic signatures that seem to be associated with certain cancer phenotypes," remarked the principal investigator of the trial Lin- wah Yip, M . D . Dr . Yip and her colleagues saw these emerging geno- type-phenotype associations as a potential answer to a mul- titude of questions prompted by new guidelines released by the American Thyroid Association (ATA) in 2015 . In contrast to earlier editions, which recommended complete thyroid removal for virtually all cancers, the latest edition advocates less aggressive treatments for low-risk cancers, including removal of only half the thyroid, and less frequent use of radioactive iodine treatment . One reason the new guidelines emphasize less aggres- sive treatment for low-risk cancers is that the discovery of small cancers found incidentally during imaging studies "If we could cut the healthcare dollars spent on unnecessary thyroidectomies, [we would achieve] a wonderful goal." —Sally Carty, M.D., UPMC

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