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A safer and shorter treatment for thyroid cancer
12 December 2014
The HiLo trial has changed management for patients with well-differentiated thyroid cancer. The new treatment standard is more convenient for patients, with fewer side effects, and reduced costs to the health service.
Thyroid cancer affects around a quarter of a million people every year around the world. It is one of the few cancers where the incidence is increasing, and unlike most cancers, it is common among younger people. Fortunately, the cure rate for most cases is already high. Research in this field aims to develop new treatments that are safer, cheaper or easier to administer.
Most patients receive a high dose of radioactive iodine after surgery. In 2007, Professor Allan Hackshaw (Cancer Research UK and UCL Cancer Trials Centre) led a comprehensive systematic review to examine low versus high dose radioactive iodine. This showed that there was insufficient evidence to use a low dose. As a result, Cancer Research UK funded a large trial, co-ordinated through UCL (with Dr Ujjal Mallick, Newcastle, as chief investigator), to evaluate this properly.
The HiLo trial was the first national thyroid cancer study in the UK. The results showed that doses could be reduced to just one third of previous levels, and it also showed that giving a drug called Thyrogen before radioactive iodine greatly improves quality of life during treatment, and helps the body to remove the radioactive iodine faster. This new approach can be delivered as outpatient treatment, which is quicker and easier for patients; allowing them to get on with their family and work lives. There are also fewer side effects than with the high dose, and a lower chance of further cancers developing over the following decades. The study predicted a 14% cost saving to the NHS compared to the previous treatment (high dose without Thyrogen).
UK and US guidelines have been modified to recommend low dose therapy with Thyrogen, and many clinicians are already implementing the change.
Thyroid cancer affects many young and middle aged people, including those who have children or are in work. Reducing the amount of treatment these patients get, without detriment, has been a goal for many years. The HiLo trial shows that this can be done, making the treatment journey easier and less stressful. - Professor Allan Hackshaw