Abstract
KEY POINTS
This annual meeting of the International Thyroid Oncology Group included a program that explored novel molecular-driven research into disease mechanisms, promoted the development of novel therapeutic innovations, and informed and expanded research collaboration and data sharing to facilitate cures for advanced thyroid cancers.
SUMMARY
The 2026 annual meeting of the International Thyroid Oncology Group (ITOG) was held in Duarte, California, from April 15 to 17, 2026; it was hosted by Drs. Terence Williams and Sasan Fazeli of the City of Hope and chaired by Dr. Laura Boucai. From theranostic innovations and expanded understandings of the molecular drivers of disease to early clinical trial data of novel therapeutics, the 2026 ITOG annual meeting drives ongoing innovations and expands collaborative science to propel research geared to creating a cure for advanced thyroid cancer.
Keynote speaker Dr. Terence Williams started the meeting with an outline of the development of radiation therapy and the ongoing efforts to personalize treatment to widen the therapeutic index by selectively killing tumor cells while minimizing normal tissue toxicity. He highlighted novel radiosensitizing strategies to combat radiation resistance in BRAF-mutated and BRAF wild-type anaplastic thyroid cancer.
Drs. Jack Shively and Jeff Wong delivered the second keynote presentation outlining the development of carcinoembryonic antigen (CEA)–based theranostics to develop a highly sensitive and specific monoclonal antibody used for both targeted imaging and therapy purposes. They then transitioned to illustrate phase 1 clinical trials with CEA chimeric radioimmunotherapy, which improves detection of metastatic disease in medullary thyroid cancer (MTC) and may inform treatment decisions for locoregional versus systemic therapy for advanced disease.
The third keynote speaker, Dr. Christine Brown, outlined the history of chimeric antigen receptor T-cell (CAR-T) therapy development for solid tumors, noting the extensive research in this area, with over 400 active clinical trials internationally and several treatments recently approved by the U.S. Food and Drug Administration (FDA). She highlighted the safety and efficacy of CAR-T therapy in glioblastoma and a novel multicenter phase 1 clinical trial at three sites in California that included patients with advanced thyroid cancer.
Scientific symposia were divided by tumor type, with the opening session focused on differentiated thyroid cancer). Dr. Eric Sherman described developing research with next-generation BRAF inhibitors in phase 1 and phase 2 clinical trials, designed to overcome methods of tyrosine kinase inhibitor (TKI) resistance. Dr. Aditya Shreenivas discussed the clear unmet need for improved treatment options in radioiodine-refractory thyroid cancer and highlighted the novel molecules and radiopharmaceutical trials that are ongoing. He focused on the barriers and possible treatment solutions addressing the immunosuppressive tumor microenvironment, T-cell exhaustion in solid tumors, antigen heterogeneity and escape, and manufacturing delay and scalability to promote CAR-T therapy in advanced thyroid cancer. Dr. Nikita Pozdeyev presented expanded results from the Virtual Thyroid Biopsy Consortium, a global collaborative effort that includes over 2.9 million participants, with development of a polygenic risk score aimed at identifying individuals at risk of developing high-risk thyroid cancer among other genetically driven thyroid conditions. 1 Dr. Al Copland presented novel preclinical data about CAR-T therapy targeting the thyroid stimulating hormone receptor, which have shown potent antitumor activity in preclinical and mouse models. Dr. Mable Ryder then presented updated cohort data from 39 patients treated with pemetrexed–carboplatin for advanced DTC, after multiple lines of therapy, showing durable, well-tolerated clinical responses warranting further research. Dr. Vineeth Sukrithan expanded on this research, presenting development of a phase 2 clinical trial with pemetrexed–carboplatin and amivantamab to target both epidermal growth factor receptor and mesenchymal–epithelial transition factor. This trial will soon open to accrual. Lastly, Dr. Lova Sun briefly presented the open phase 3 clinical trial of patients with advanced BRAF-mutated DTC in whom first-line multikinase (MKI) therapy failed, randomly assigning patients to either BRAF-targeted therapy or second-line MKI inhibitor therapy. Accrual for this study (NCT06475989) is open; it is seeking patient referrals for treatment.
The oncocytic thyroid cancer (OTC) symposium included three linked presentations by Drs. Prashant Mishra, David McFadden, and Jong-In Park, highlighting new collaborations and synergy among researchers to expand our understanding of the biology of OTC. Dr. Mishra started with the role of mitochondrial DNA in the development and metastatic spread of OTC. Dr. McFadden then expanded on the role of complex 1 impairment as a defining feature in OTC and the potential role of germline mutations to drive tumor progression. Dr. Park highlighted the estrogen-related receptor alpha–mortalin axis as a key regulator of the mitochondrial effects and subsequent driver of OTC tumorigenesis, thereby supporting its role as a potential future therapeutic target.
Dr. Thomas Roberts introduced the MTC symposium by presenting data on a small institutional cohort of patients treated off-label with tarlatamab for treatment-resistant MTC. Although initial biochemical and radiographical outcomes were positive, severe treatment-related side effects have prompted development of an alternative step-up dosing strategy and a comprehensive institutional protocol to manage side effects. Dr. Rosella Elisei highlighted the key differences in clinical outcomes in MTC patients who do not harbor RET mutations when treated with MKI therapy. She then focused on work using whole-exome sequencing of familial clusters with MTC without germline mutations, noting novel oncosuppressor genes discovered and ongoing expansion of the genomic environment of MTC. Dr. Joanna Klubo closed the session with a discussion of novel targets for peptide receptor radionucleotide therapy for selected patients with progressive metastatic MTC.
The anaplastic thyroid cancer (ATC) symposium included a series of talks focusing on novel areas of potential therapeutic advances and early clinical trial data for this incredibly challenging and aggressive disease. Dr. Romana Netea-Maier noted the role of myeloid cells in ATC, which represent a potential therapeutic target. Dr. Kartik Sehgal noted the lack of FDA-approved treatments for non–BRAF-mutated ATC and presented phase 2 clinical trial data using dual immune checkpoint blockade, a highly promising treatment for incurable ATC, especially in patients for whom MKI therapy is contraindicated. Dr. Anastasios Maniakas then presented fascinating preclinical data of a pan-RAF kinase inhibitor shown to potently inhibit both wild-type and mutated RAF kinases in cell-free and cell-based assays. This novel molecule tested on cell lines resistant to BRAF/MEK inhibitors shows potential as a single-agent treatment or in combination with targeted BRAF-directed therapy. Dr. Sarah Hamidi closed the session by presenting institutional cohort data for stage 4C ATC using a protocol of palliative radiation therapy followed by treatment with lenvatinib and pembrolizumab and then reconsideration of primary surgical resection depending on the clinical response. This approach has shown significant improvement in clinical outcomes for patients with severe disease and prompted a rousing discussion about the heightened risks of surgery and treatment-related complications, noting the need for highly specialized surgical care in this setting. This exciting symposium really highlighted the advances in treatment options for patients with the most aggressive ATC.
The pediatric and redifferentiation symposium highlighted the ongoing work to broaden our understanding of pediatric and radioiodine-refractory disease. 2 Dr. David Pattison presented the Australian approach to redifferentiation therapy in the Intensive Prospective Multi-Centre Trial of TKI Redifferentiation Therapy (I-FIRST) trial, a phase 2 open-label nonrandomized study currently working to enroll 80 patients for redifferentiation therapy using I-124 PET dosimetry to assess response and guide I-131 dosing. Dr. Aime Franco then emphasized the molecular profile differences between adult and pediatric thyroid cancer, with a higher prevalence of kinase fusions in the pediatric population. She highlighted Thyroid Therapy to Increase RAI Uptake in Patients with Metastatic Differentiated Thyroid Cancer (TRAIT), a redifferentiation study for pediatric patients that is currently enrolling at multiple sites in the United States. Lastly, Dr. Laura Boucai highlighted the importance of lesional dosimetry in optimizing RAI therapy both with and without redifferentiation therapy to improve targeting treatment of metastatic disease.
The final symposium focused on the role of neoadjuvant therapy for advanced thyroid cancer. Dr. David Shonka presented progress on the ITOG and American Head and Neck Society joint position statement on neoadjuvant therapy that is in development. Using a modified Delphi method, the white paper will focus on the landscape of solid tumor neoadjuvant therapy in other solid tumors before narrowing into the thyroid-specific considerations for treatment and highlights on metrics to quantify success. Dr. Gregory Randolph then presented on the ITOG neoadjuvant registry in development to allow for aggregated reporting on outcomes and complications of treatment. Drs. Mark Zafereo and Sid Sheth presented new ITOG neoadjuvant protocols (NCT06959511 and NCT06902376), both currently recruiting patients.
The symposium closed with the presentation of recent trial data from completed protocols, including neoadjuvant pembrolizumab with dabrafenib and trametinib for BRAF V600E–mutated ATC, neoadjuvant selpercatinib for RET-altered differentiated thyroid cancer, including MTC, and neoadjuvant lenvatinib for locally advanced differentiated thyroid cancer.
The meeting wrapped up with updates on current ITOG-sponsored projects, including the secondary resistance registry led by Dr. Rory Clifton-Bligh, designed to characterize molecular alterations in advanced thyroid cancer treatment with targeted kinase inhibitor therapy with subsequent development of resistance. Dr. James Fagin closed the session by presenting the Robert Gagel Award Lecture on the immune microenvironment of ATC, focusing on the response of BRAF-mutated ATC to MAPK inhibitors, describing the microenvironmental factors that are required for a therapeutic response to BRAF-targeted therapy and highlighting the areas for future research to focus on to improve treatment of ATC.
The 2026 ITOG annual meeting brought together specialists and leaders from across the world, strengthening global collaboration and dialogue in support of ITOG’s mission to accelerate progress toward curing advanced thyroid cancer.