Innovations in Aggressive Thyroid Cancer Treatment

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology-head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I am looking forward to speaking with Dr. Joseph Scharpf, Director of Head and Neck Endocrine Surgery at Cleveland Clinic, and Vice Chair Professional Development and Continuing Education in our Head and Neck Institute. Dr. Scharpf, welcome to Head and Neck Innovations.

Joseph Scharpf: Thanks, Dr. Bryson.

Paul Bryson: Hey, well, let's start by having you share some background on yourself for our listeners, where you're from, where you trained, and how you came to Cleveland Clinic.

Joseph Scharpf: Sure. I've been at the Cleveland Clinic for many years. I did my medical school training at Ohio State, at that point in time actually the Cleveland Clinic was a teaching hospital for Ohio State. I did some rotations here and I wanted to do my residency here. And so, I did my residency here about 25 years ago. I started, and then I went away for a year for a head and neck fellowship in Iowa but came right back to start my career and I haven't left, and I've enjoyed every moment of it.

Paul Bryson: Well, it, it's been great to work alongside you for the last, you know, many years now, and you've been very busy academically, you know, always lots of contributions, particularly you've been busy in the realm of thyroid cancer research, and I was hoping you could tell us about your team's work on a recently published 21 year study on the association of treatment strategies and tumor characteristics with overall survival among patients with anaplastic thyroid carcinoma. You know, this was featured in JAMA Otolaryngology earlier this year and we actually spoke about it on that podcast, but can you share with the listener a little bit about this and some of your other work?

Joseph Scharpf: Sure. Anaplastic is a unique, and it's a rare cancer of the thyroid gland. It's unfortunately one of the most devastating cancers anyone could get for any organ, and we've had a very extensive experience with you at such a big tertiary care center, and so we've been focused on it. We wanted to look back to see what our traditional experience had been with anaplastic thyroid cancer in this particular study. And it was similar to many other major centers' experiences in terms of prognosis for patients being quite poor. But we're looking to the future with a better optimistic viewpoint because better treatments have now come about for patients, particularly with molecular testing. If they're BRAF positive, there's studies that they can go into and now have some patients where they're getting adjuvant treatment and then going to surgery, which was things I wasn't expecting to see in my lifetime for being able to offer hope for patients with anaplastic thyroid cancer. And so, by doing this study, we, we got a baseline of where we're going, where we were, and now we're looking to the future to see where things will go with new adjuvant treatments and then potentially surgery after those treatments.

Paul Bryson: Yeah, it's a pretty exciting time, like you said, you know, going through medical training not that long ago. Anaplastic, you know, felt like a pretty terminal diagnosis, but it's been pretty amazing to see the evolution of that sort of new therapies.

Joseph Scharpf: Yeah. But it's been remarkable, and the molecular testing can be such a game changer for patients. And so, within our team, we have a very multidisciplinary team effort as you need to have for this cancer. We get patients in immediately that day for some one of our providers too, to see them getting biopsies rapidly is critical. And then we've gotten patients on two treatments rapidly within a day or two, and it's made a huge difference of trying to sustain an airway, so they don't need a tracheotomy trying to get tumor control and, and giving them hope, as I said.

Paul Bryson: Well, last month, I know you attended the American Head and Neck Society's 11th International Conference on Head and Neck Cancer. We had Eric Lamarre on the podcast briefly to touch on some of the research that our team and your team presented, but can you dive a little deeper into some of your research that was presented at that meeting?

Joseph Scharpf: Sure. There was, there's a few activities that we're involved with. So, I chaired the professional education committee within the HNS endocrine section, and so we had a day dedicated to endocrine the day before the official meeting. So, within that, there are a variety of topics. I spoke on molecular targets as we're talking about identifying populations with aggressive variants and how critical a role that plays for patients. And so, I was involved with that and showed some of our research and some of our cases. And then later in the conference, I was actually involved at the other end of the spectrum on a panel for patients with lower stage thyroid cancer and some of the controversies that arise from how to manage those patients and to find a proper balance for them so that you're not overly aggressive with your treatment, which could have consequences for quality of life and, and looking to still get good oncologic outcomes for those patients. And that was a great session, well attended by many. And so, I enjoyed the whole meeting and interacting with the folks from both ends of the spectrum of the worst cancer to very favorable cancers, which are the majority of cancers with thyroid.

Paul Bryson: Yeah. Well, what else is on the horizon as far as some additional research that you and the team are working on? I had heard, you know, maybe a clinical trial, things like that. What, uh, what's in the pipeline for your team?

Joseph Scharpf: Yeah, we're, we're fortunate. We also have a clinical trial going on right now. We're a site for a clinical trial. It actually started at MD Anderson. But there's a couple of sites within the country and we've been involved with it, where patients are getting dabrafenib and trametinib and pembro for BRAF positive tumors. And then we're operating on those patients. I've already operated on patients, and we have some in treatment right now who we'll be operating on. So that's exciting and that's giving some new hope for patients. So, we are involved with clinical trials there. We have a very vibrant basic science research group with world renowned researcher Jeff Knauf. Dr. Knauf came from Memorial Sloan Kettering and is a world-renowned researcher in anaplastic thyroid cancer. I'm hoping as time goes on, we will have other options of clinical trials that we will generate from our own group. One of my partners who's a newer to our group, Dr. Natalie Silver, is working on mRNA Technologies. It'd be wonderful to look at potential vaccination trials for anaplastic cancer or other head and neck cancers. But yeah, there's a lot of exciting avenues that we're looking to go into in the future.

Paul Bryson: Well, we're also excited about this fall's course that you're co-directing. It's the 2023 Contemporary Multidisciplinary Care of the Head and Neck Cancer Patient. This is updates on the innovative approaches to head and neck cancer treatment, and it's going to be taking place at our main campus on Friday, November 17th. Can you give a preview for our listeners? This has been a course, you know, I've been here about 13 years. It's been a course that you are consistently, and the team put on, and it has evolved over the years, give us a preview. What are you excited about with this iteration?

Joseph Scharpf: We're excited to have it back live again. We started the course in about 2010, and it was a live course every year. We would invite national speakers, but then also have great talks from our own group. It's a true multidisciplinary course where we have our radiation medical oncologists, other members of our team come and speak from other sections. There was a break in interruption during the height of the pandemic where we did not have it live. And so now we're back to life again, and we're very, very excited to do it. And so, on this particular course this year, I'm going to co-direct with one of my partners, Dr. Jamie Ku. And then we have everyone from our group speaking as well as from our other groups in medical and radiation oncology. We've dedicated a little bit different this year to make it a bit of an alumni day also. And so, I am very excited that not only are we going to have some very well-known speakers and the chairman at University of Chicago Nishant Agrawal, and then Dr. Cardoso from MD Anderson, but we're bringing back one of our recent fellows, Dr. Scott Roof. And so, I'm very excited that we're bringing back a younger staff member earlier in his career to give us some lectures and promote him in his career. So, it's dedicated to our alumni, and we're looking for a great course for that day.

Paul Bryson: Well, I'm sure it'll be excellent, you know, having participated in it in years past, it's like a really great group. And, you know, for anyone listening, you know, I'll, I'll give you some contact information here, but it's a very worthwhile meeting and well-conceived.

Joseph Scharpf: Thank you. Yeah. We've always appreciated the great lectures you've given, and the other members of our group. And I think that's what makes it special, is that it's a true multidisciplinary meeting. And so, it, it really shows the value of our multidisciplinary approach here in general for what we do for our patients.

Paul Bryson: Well, for more information and to register for November's Head and Neck Cancer Course, please visit CCFCME.org/headandneck2023. That's CCFCME.org/headandneck2023. And to speak with one of our specialists or submit a referral, please call our cancer answer line at 866.223.8100. That's 866.223.8100. Dr. Scharf, thanks for joining Head and Neck Innovations.

Joseph Scharpf: Yeah, thanks a lot, Dr. Bryson. It's always a pleasure.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website at clevelandclinic.org\podcasts, or you can subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. Don't forget, you can access real-time updates from Cleveland Clinic experts in otolaryngology - head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.