Patients must have histologically or cytologically diagnosed advanced anaplastic thyroid cancer (ATC)
Group : Anaplastic thyroid cancer
Patients with active, known or suspected autoimmune disease except for autoimmune thyroiditis or vitiligo. Thyroiditis patients must be asymptomatic, on adequate thyroid replacement and have normal thyroid function tests.
Subjects who experienced immune related pneumonitis, pituitary or thyroid dysfunction, or pancreatitis while on treatment with immuno-oncology agents
Patients who require thyroid replacement therapy are not eligible if they have not been receiving a stable replacement dose for at least weeks prior to study enrollment
Phase Cohort C (thyroid cancer): Subjects must have a histologically or cytologically confirmed diagnosis of metastatic thyroid cancer (stage IV) that carries either a RET rearrangement or activating RET mutation, as determined by FISH, RT-PCR, or NGS via a CLIA-certified LDT
Normal thyroid and pituitary functions
Uncontrolled thyroid disease or cystic fibrosis.
Thyroid function tests must be consistent with stable thyroid function; patients on a stable dose of thyroid replacement therapy for a suggested minimum of weeks before cycle , day are eligible
For papillary thyroid carcinoma patients:
Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone may be eligible for this study.
Patients who require thyroid replacement therapy are not eligible if they have not been receiving a stable replacement dose for at least weeks prior to study enrollment.
Eligible patients must have histopathologically confirmed Hrthle cell thyroid cancer by central review
Thyroid Carcinoma
Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone are eligible
For the Phase I part of the study, eligible patients must have incurable poorly differentiated thyroid cancer; OR anaplastic thyroid cancer; OR radioiodine refractory differentiated thyroid cancer that is refractory to a tyrosine kinase inhibitor (TKI); OR patients who cannot tolerate a TKI are also eligible; histological confirmation of poorly differentiated, undifferentiated or anaplastic histology is required for untreated cases, but is not required for the refractory cases
Patients with a history of autoimmune hypothyroidism (such as atrophic thyroiditis) on a stable dose of thyroid replacement hormone may be eligible.
Pre-existing thyroid abnormality with thyroid function that cannot be maintained in the normal range with medication
Baseline abnormal thyroid function tests
Adequately controlled thyroid function, with no symptoms of thyroid dysfunction; patients can be on thyroid hormone replacement medication; asymptomatic patients with elevated thyroid-stimulating hormone (TSH) with normal T/T are allowed to enroll, and recommended to follow with routine thyroid function test especially if they are randomized to cediranib/olaparib arm
Metastatic, radioactive iodine (RAI) refractory, differentiated thyroid cancer (including papillary and follicular thyroid cancer and their sub-types such as Hurthle cell thyroid cancer as well as poorly differentiated thyroid cancer); RAI refractoriness is defined as absence of uptake of RAI on either a low dose diagnostic test or a post-treatment RAI scan in measurable lesions or radiographic progression of disease within months of the last course of RAI treatment despite the recorded uptake of RAI with that previous therapy or having a cumulative lifetime administered dose of greater than mCi.
Patients must have histologically or cytologically confirmed thyroid carcinoma of follicular origin (including papillary, follicular, Hurthle cell or poorly differentiated subtypes and their respective variants)
Diagnosis of recurrent and/or metastatic thyroid cancer
Pathologically (histologically or cytologically) proven diagnosis of anaplastic thyroid cancer (a diagnosis that is noted to be consistent with anaplastic thyroid cancer is acceptable)
Patients must have histologically confirmed medullary thyroid cancer by the laboratory of pathology or a pathology report and history consistent with medullary thyroid cancer; it is not uncommon for a secondary, minor pathologic focus of another form of thyroid cancer to be coincidentally found in -% of patients with medullary thyroid cancer; in such cases, eligibility is based on the discretion of the investigator
Adequately controlled thyroid function, with no symptoms of thyroid dysfunction; elevated thyroid stimulating hormone (TSH) with normal T and T are allowed; patients on thyroid replacement therapy are allowed
Patients with thyroid dysfunction if not adequately controlled
Differentiated thyroid cancer
Planned total, near-total or completion thyroidectomy requiring lifelong thyroid hormone replacement
Undifferentiated, anaplastic or medullary thyroid cancer
Clinically euthyroid; Note: patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
Histologically or cytologically confirmed diagnosis of anaplastic thyroid cancer or undifferentiated thyroid cancer; a diagnosis of possible anaplastic thyroid cancer (ATC)/undifferentiated thyroid cancer (UTC) will be allowed if the clinical presentation is consistent with anaplastic or undifferentiated thyroid cancer
Clinically euthyroid; note: patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
Subject has uncontrolled thyroid dysfunction
Cohort A: Differentiated Thyroid Cancer (DTC) with one of the following histological subtypes: i) Papillary thyroid cancer (PTC). i.a) Follicular variant. i.b) Other variants (including but not limited to tall cell, columnar cell, cribriform-morular, solid, oxyphil, Warthin's-like, trabecular, tumor with nodular fasciitis-like stroma, Hurthle cell variant of papillary carcinoma, or poorly differentiated carcinomas). ii) Follicular thyroid cancer (FTC). ii.a) Hurthle cell. ii.b) Clear cell. ii.c) Insular. c) Cohort B, A, and B: Relapsed or refractory osteosarcoma.
Patients must have histologically or cytologically confirmed at least thyroid nodule that is >= cm but =< cm measured in greatest dimension and confirmed by the Laboratory of Pathology, National Cancer Institute (NCI) or confirmed by the pathology laboratory of enrolling institution:\r\n* Indeterminate thyroid biopsy per Bethesda System for reporting thyroid cytopathology with BRAF VE mutation or RET/positron emission tomography (PET) rearrangement\r\n* Cytologically or histologically suspicious or confirmed PTC per Bethesda System for reporting thyroid cytopathology
Patients who have had previous thyroid surgery
Patients must have histologically or cytologically confirmed thyroid carcinoma of follicular origin (including papillary, follicular, or poorly differentiated subtypes and their respective variants); confirmation of thyroid carcinoma will be done at Memorial Sloan-Kettering (MSK)
Previous thyroid surgery
No uncontrolled thyroid disease (e.g. hyperthyroid/hypothyroidism)
Diagnosis of recurrent and/or metastatic thyroid cancer
Histological or cytological confirmation of thyroid carcinoma of follicular origin (including papillary, follicular, or poorly differentiated subtypes and their respective variants); NOTE: medullary and anaplastic thyroid cancers are excluded; Hurthle cell carcinomas are excluded (defined as having an invasive tumor composed of > % oncocytic [Hurthle] cells lacking the nuclear features of papillary carcinoma, tumor necrosis, and marked mitotic activity); patients with oncocytic (Hurthle cell) variants of papillary thyroid carcinoma (defined as a tumor composed of a majority of oncocytic [Hurthle] cells having the nuclear features of papillary carcinoma) are eligible to participate
Patients with medullary thyroid cancer
Confirmed diagnosis of differentiated thyroid cancer (follicular or papillary thyroid cancer and their variants)
Adequately controlled thyroid function, with no symptoms of thyroid dysfunction; patients can be on thyroid hormone replacement medication; asymptomatic patients with elevated thyroid stimulating hormone (TSH) with normal T/T are allowed to enroll, and recommended to follow with routine thyroid function test
Patients with thyroid disease should be excluded unless euthyroid on suppressive or replacement therapy
Histological confirmation of, or cytology reported and confirmed, anaplastic thyroid cancer in thyroid mass and/or regional lymph nodes\r\n* NOTE: A diagnosis reported as poorly differentiated carcinoma consistent with anaplastic thyroid cancer will be accepted
Patients who require thyroid replacement therapy are not eligible if they have not been receiving a stable replacement dose for at least days prior to study enrollment; patients who enter the study on thyroid replacement should have their medication adjusted to maintain thyroid-stimulating hormone (TSH) in the normal range
Clinically euthyroid; note: patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
T within normal limits; if abnormal and patient is receiving thyroid replacement therapy, the thyroid medication may be adjusted and the T may be re-tested
Diagnosis: Patients must have histologically confirmed medullary thyroid cancer by the Laboratory of Pathology or a pathology report and history consistent with medullary thyroid cancer; it is not uncommon for a secondary, minor pathologic focus of another form of thyroid cancer to be coincidentally found in -% of patients with medullary thyroid cancer; in such cases, eligibility is based on the discretion of the investigator
Pathologically (histologically or cytologically) proven diagnosis of anaplastic thyroid cancer (a diagnosis that is noted to be consistent with anaplastic thyroid cancer with the presence of a thyroid mass is acceptable)\r\n* Note: tissue collection for central review is mandatory, but central review is not required for eligibility; treatment will be started prior to central review
Patient must not have pre-existing thyroid abnormality with thyroid stimulating hormone that cannot be maintained at less than or within the normal range with medication
Thyroid dysfunction not adequately controlled
Thyroid dysfunction not adequately controlled
An incidental focus of medullary thyroid cancer (MTC), DTC, and/or poorly differentiated thyroid cancer in a participant with ATC is allowed.
Symptomatic thyroid disease, unless negative for thyroid antibodies (TSH receptor, TPO, thyroglobulin).
Pre-existing thyroid abnormality with thyroid function that cannot be maintained in the normal range with medication
Uncontrolled thyroid dysfunction
Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone may be eligible.
Adequately controlled thyroid function, with no symptoms of thyroid dysfunction
Treated medullary or papillary thyroid cancer
Patients with a pre-existing thyroid abnormality who are unable to maintain thyroid function in the normal range with medication are ineligible; patients with a history of hypothyroidism are eligible provided they are currently euthyroid
Patients must have histologically or cytologically confirmed thyroid carcinoma of follicular origin (including papillary, follicular, or poorly differentiated subtypes and their respective variants)
Neuroendocrine cancer of the thyroid or thymus.
Any uncontrolled thyroid disease
Evidence of thyroid or soft tissue invasion (stage cT)
Inclusion Criteria:\n\n Differentiated thyroid cancer Tumor > cm, or Gross extra-thyroid extension, or lymph\n node > cm, or or more lymph nodes of any size Previous thyroidectomy Must be able to\n receive radioactive iodine therapy Must be able to receive Thyroid Stimulating Hormone\n suppression\n\n Exclusion criteria:\n\n Metastaic disease Anaplastic thyroid cancer, medullary thyroid cancer or Hurthle cell\n carcinoma Presence of anti-Tg antibodies Previous treatment with any radiation Unresolved\n toxicity ? common terminology criteria for adverse event Grade
Patients must have histologically or cytologically confirmed papillary thyroid cancer, follicular thyroid cancer (tall cell variant, insular thyroid cancer, follicular variant of papillary thyroid cancers, poorly differentiated thyroid cancer or any of the above mixed histology will be allowed); patients with anaplastic thyroid cancer are excluded
Patients with a pre-existing thyroid abnormality who are unable to maintain thyroid function in the normal range with medication are ineligible
Clinically euthyroid; Note: Patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
Prior treatment with not more than systemic agent (including chemotherapy or biologic agent e.g. vandetanib for patients with medullary thyroid cancer)
Clinically euthyroid; Note: patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
Histopathologic confirmation of anaplastic thyroid cancer (or histopathologic report consistent with anaplastic thyroid cancer) at Memorial Sloan Kettering Cancer Center with clinical evidence of metastatic disease not curable by either surgery or radiation therapy
Patients with a history of autoimmune hypothyroidism AND without normal thyroid hormone levels on a stable dose of thyroid replacement hormone
Patients with well differentiated thyroid cancer are eligible for protocol as follows:
For anaplastic thyroid cancer (ATC), patients must have histologically or cytologically diagnosed advanced ATC.
Thyroid dysfunction not responsive to therapy
Subjects known to have an uncontrolled thyroid disorder.
Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone may be eligible.
Uncontrolled thyroid disease
Patients on active treatment for hypo- or hyperthyroidism that is uncontrolled, requiring new medication, treatment intervention (such as thyroid ablation or surgery), or a > % medication dose adjustment within the previous months; patients on stable doses of thyroid hormone replacement for hypothyroidism or thyroid suppression for hyperthyroidism can participate
localized thyroid cancer
SUNITINIB MALATE ARM: Patients with a pre-existing thyroid abnormality who are unable to maintain thyroid function in the normal range with medication are ineligible
The subject has concurrent uncompensated hypothyroidism or thyroid dysfunction within days before the first dose of study treatment
Thyroid cancer histology or cytology that is aggressive (anaplastic/undifferentiated thyroid cancer, poorly differentiated thyroid cancer, Hurthle cell carcinoma, tall-cell variant of papillary thyroid cancer, sclerosing variant of papillary thyroid cancer)
Other investigational agents within weeks prior to study treatment, except for subjects with anaplastic/undifferentiated thyroid cancer who may be enrolled immediately of discontinuation of previous therapy
Patients must have histologically or cytologically confirmed thyroid carcinoma of follicular origin (including papillary, follicular, or poorly differentiated subtypes and their respective variants).
Patients with thyroid disease should be excluded unless their T is normal or they are on replacement therapy
Therapy with rosiglitazone (Avandia) or pioglitazone (Actos) at any time since the diagnosis of thyroid cancer
Thyroid function abnormality ? Grade
Uncontrolled thyroid disease or cystic fibrosis
Patients with a pre-existing thyroid abnormality who are unable to maintain thyroid function in the normal range with medication are ineligible
treated medullary or papillary thyroid cancer
Patients must not have active or history of clinically significant autoimmune disease, defined as requiring systemic therapy; type II diabetes, vitiligo, stable hypothyroidism, and thyroid disease well controlled with thyroid replacement will not be considered exclusion criteria
Clinically euthyroid; Note: patients are permitted to receive thyroid hormone supplements to treat underlying hypothyroidism
Patients who are not biochemically euthyroid; patients with known history of hypothyroidism are eligible if they are on adequate and stable replacement thyroid hormone therapy for at least months
Subjects must be diagnosed with differentiated thyroid cancer
Patient must not have any uncontrolled thyroid disease
Use of thyroid medication at the time of screening
Participants with thyroid carcinoma or thyroid disease for whom systemic radioactive iodine therapy is part of planned diagnostic work-up or treatment within months following the contrast mammogram study.
Participants with thyroid carcinoma or thyroid disease for whom systemic radioactive iodine therapy is part of planned diagnostic work-up or treatment within months following the contrast mammogram study
History of known thyroid disease
History of known thyroid disease
History of thyroid cancer
Patients must have histologically or cytologically confirmed thyroid carcinoma of follicular origin (including papillary and its respective variants)
Patient must be status post near total thyroidectomy for differentiated thyroid cancer without known distant metastases and who are planning to undergo routine remnant thyroid tissue ablation with I-
Patients must qualify for thyroid ablation with I-
Known metastatic thyroid cancer
Participants with thyroid carcinoma or thyroid disease for whom systemic radioactive iodine therapy is part of planned diagnostic work-up or treatment within months following the contrast mammogram study
Participants with actively treated thyroid disease who still have a portion or all of their thyroid gland
Participants with a history of Graves disease, goiter, thyroid nodules, Hashimotos thyroiditis, post-partum thyroiditis, type amiodarone-induced thyrotoxicosis, or subacute thyroiditis who still have a portion or all of their thyroid gland
Abnormal thyroid function, such as untreated clinical diagnosis of hypothyroidism, hyperthyroidism, or other thyroid disease
Have an undiagnosed suspicious solid or mostly solid thyroid nodule.;
Patient with thyroid cancers
Biopsy proven papillary thyroid cancer (regardless of genotype and including all subtypes such as follicular or mixed papillary follicular) or suspicious for thyroid cancer
Thyroidectomy or lobectomy planned as definitive treatment for thyroid cancer or patients on active surveillance management approach
Subjects must have either primary or recurrent papillary thyroid cancer (PTC) or medullary thyroid carcinoma (MTC) with nodal metastases detected through physical examination and/or standard imaging techniques
Locally recurrent and unresectable and/or distant metastatic differentiated thyroid cancer (DTC), histologically or cytologically confirmed; the diagnosis of DTC includes the following subtypes: papillary thyroid cancer (PTC) (including but not limited to variants such as follicular variant, tall cell, columnar cell, Hurthle cell variant of papillary carcinoma, and poorly differentiated), follicular thyroid cancer (FTC), including insular variant, Hurthle cell carcinoma and poorly differentiated thyroid cancer
Preoperative fine needle aspiration cytology classified as papillary thyroid carcinoma or suspicious for papillary thyroid carcinoma.
Patients with a history of prior thyroid/parathyroid surgery will be excluded from the study.
Use of thyroid replacement medication (Synthroid or similar) for < year
Patients who have already undergone any thyroid surgery will be excluded
History of autoimmune disorders, including rheumatic diseases and thyroid disorders. Exception: As with bone marrow donations, donors with a history of thyroid disease who have undergone successful therapy may be suitable.
Individual pediatric patient with current or previous known or suspected thyroid cancer or nodule(s)
Individuals from families with a high suspicion of hereditary thyroid cancer:\r\n* Families with a current or previous diagnosis of a thyroid cancer/nodule occurring in childhood (< years old)\r\n* Families with a high suspicion of hereditary thyroid cancer/nodules other than above to include:\r\n** Families with thyroid cancer in multiple individuals\r\n** Families with thyroid cancer and a known genetic syndrome\r\n** Families with thyroid cancer and a suspected genetic syndrome (e.g. multiple childhood cancers in the family, multiple primary cancers, multiple endocrinopathies, etc.)
Only measureable disease (primary or metastatic) is located in or near the thyroid gland, liver, kidney, or urinary bladder.
Papillary thyroid cancer (PTC)
Follicular thyroid cancer (FTC)
Anaplastic or medullary carcinoma of the thyroid.