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Our Research Advantage

The Section of Endocrine Surgery performs research in endocrine neoplasia, encompassing diseases of the thyroid, parathyroid, adrenal, and pancreas glands. The group comprises:

  • Surgeons
  • Endocrinologists
  • Radiation oncologists
  • Residents
  • Fellows
  • Health services researchers
  • Epidemiologists
  • Psychologists
  • Biostatisticians

The multidisciplinary nature of this group makes it ideal to tackle the pressing issues of endocrine neoplasms and work toward bridging gaps in patient care at the individual and population levels.

Our research is focused on the different diseases of the thyroid, parathyroid, pancreas, and adrenal glands. Although our primary focus is health services research and health outcomes, we are invested in examining different issues along the continuum of patient care, including:

  • Translational research
  • Cancer genetics
  • Environmental impact on cancer development
  • The psychological and economic impact on patients of endocrine diseases and their subsequent treatment
  • Patients’ decisions regarding the different diagnostic and treatment strategies available to them

Research Topics

  • Health services research
  • Translational research: The endocrine neoplasia group has an encompassing interest in cross-disciplinary translational research, including parathyroid diseases (Koh), and thyroid cancer (Counter; Stapleton).
  • Cancer genetics: The endocrine neoplasia group has been using genomic data of thyroid cancer to develop a genetic signature that predicts progression (Cheng).

Research Programs and Center

Research Labs Associated with the Endocrine Surgery Research Program

Endocrine Neoplasia Research Group

The Duke Endocrine Neoplasia Research Group is committed to providing high-quality research and training in the field of endocrine neoplasia. The multidisciplinary nature of this group makes it ideal to tackle the pressing issues of endocrine neoplasms and work toward bridging gaps in patient care at the individual and population levels.

Christopher Counter, PhD

Christopher Counter, PhDDr. Counter’s lab recently discovered that MEK1/2 require copper to promote BRAF oncogenesis, making copper a plausible therapeutic target for BRAF mutant thyroid cancer, which makes up more than half of papillary thyroid cancer (PTC). Copper chelators can be well tolerated for decades with few side-effects and at low cost, therapy characteristics especially important to thyroid cancer, which is often diagnosed early in life and can require decades of remission-sustaining treatment. Following the encouraging phase II clinical trials of BRAF inhibitors in BRAF-mutated PTC, we are using both human BRAF-mutated PTC cell lines cell and a genetically engineered mouse model of BRAF-mutated PTC to determine how the well-tolerated copper chelator can be most effectively integrated into the current treatment flow for advanced PTC.

Heather Stapleton, PhD

Heather Stapleton, PhDDr. Heather M. Stapleton (Nicholas School of the Environment) are leading a research project that investigates links between exposure to flame retardant chemicals in the home environment and risks for papillary thyroid cancer. Flame retardant chemicals are used in multiple consumer products found in the home (e.g., furniture, TVs, insulation), and they are known to interfere with thyroid hormone regulation in animal models. Dr. Stapleton’s laboratory has been researching the uses, exposure, and health effects of flame retardant chemicals for more than a decade, and she is now teaming with the endocrine neoplasia research team, who have extensive experience in the study of prevalence and clinical characteristics of thyroid cancer. Collaborating with them is Dr. Kate Hoffman, an environmental epidemiologist and member of Dr. Stapleton’s research team.

DCI Cancer and the Environment Grant
The association of polybrominated diphenyl ethers and papillary thyroid carcinoma; $149,986; renewal $108,370

Qing Cheng, PhD

Qing Cheng, PhDUsing large population multiple forms of genomic data (non-silent somatic mutations, somatic copy number alterations, gene expression, and gene fusion events) of thyroid cancer, we have developed a genetic signature that predicts progression of thyroid cancer. We are now analyzing clonal evolution connections between primary thyroid cancer and metastasis, by which to develop a real-time ctDNA approach for monitoring the early events of thyroid cancer progression. These approaches would help us to delineate the subset of patients who will need aggressive treatment from those whose tumors are indolent and require less aggressive treatment/surveillance, and facilitate the development of targeted treatment strategies to enhance patient outcomes.

Clinical Trials

Tissue and Serum Acquisition Protocol for Molecular Analysis and Cell Culture in Patients Undergoing Parathyroid Surgery
The state of knowledge in this field is very limited, and investigators are faced with developing a basic understanding of potential relationships between several thousand or tens of thousands of genes and their associations with outcomes. Acquisition of parathyroid tissue and serum specimens at the time of definitive surgery for parathyroid disease is a crucial prerequisite for present and future laboratory and translational scientific programs.
Funding: NIH

Role of NGS-based ThyroSeq Panel in Cancer Diagnosis in Thyroid Nodules
Targeted next generation sequencing (NGS) platforms allow testing for tens and hundreds mutational hotspots. Additional mutational mutations in thyroid cancer have been identified, and promising markers associated with tumor prognosis have been found. By participating in this multi-institutional study, we hope to assist in the validation of these markers.
Funding: University of Pittsburgh

Thyroid Cancer and Polybrominated Diphenyl Ether (PBDE) Exposure
Excessive environmental exposure of adult patients to PBDE chemicals is associated with the development of papillary thyroid carcinoma, and may account for the increasing incidence of thyroid cancer in the United States. Clinical-translational mechanisms are used to explore the association between PBDE exposure, serum PBDE levels, and thyroid cancer.
Funding: Department/Division/Faculty/PI/Duke

Randomized Double-Blind Phase II Study of Radioactive Iodine (RAI) in Combination with Placebo or Selumetinib for the Treatment of RAI-Avid Recurrent/Metastatic Thyroid Cancers
The study examines the response of tumors following treatment with radioactive iodine in combination with placebo or selumetinib for RAIA recurrent and/or metastatic thyroid cancer.
Funding: Academic and Community Cancer Research United

RIFTOS MKI – An Observational Study in Differentiated Thyroid Cancer Which is Radioactive Iodine (RAI) Refractory to Assess the Use of Multikinase Inhibitors
This is an international prospective, open-label, multi-center, non-interventional study designed to compare treatment options in DTC. Practice patterns of care of patients with RAI-refractory DTC under real-life conditions will be evaluated.
Funding: Bayer Healthcare

Eisai – An Open-Label, Single-Arm, Multicenter, Phase 2 Trial of Lenvatinib for the Treatment of Anaplastic Thyroid Cancer (ATC)
The study will evaluate the effectiveness and safety of lenvatinib, also known as LENVIMA™, (approved by the FDA February 13, 2015 in the U.S.) in patients with anaplastic thyroid cancer (ATC).  Lenvatinib may offer a new treatment option that will be more effective than the standard drugs used for ATC by stopping the formation of new blood vessels that help cancer cells grow and spread.  Lenvatinib is taken by mouth in capsule form and is to taken on a daily basis. Lenvatinib is a drug that was approved by the FDA (the U.S. Food and Drug Administration) on February 13, 2015 in the U.S.
Funding: Eisai, Inc.