Q&A: Dr. Agosto Shares Her Role as an Endocrine Oncologist
As the only NCI-designated Comprehensive Cancer Center based in Florida, Moffitt is a national leader in Endocrine Oncology. In this Q&A, Salimar Agosto Salgado, MD, an Associate Member of the Department of Head and Neck-Endocrine Oncology, shares her experience as a dually trained physician in both Endocrinology and Oncology.
What drove you to become an oncologist?
Early during medical training, I selected to specialize in thyroid cancer and endocrine tumors, given the opportunity to make a difference in patients’ lives in different aspects. For example, as a clinician, providing expert management in the field of endocrine neoplasia for me goes strongly in hand with ensuring patients are educated on their condition and providing patient-centered care. In addition, as thyroid cancer is a type of malignancy with a favorable prognosis in most cases, this has been sadly many times been confused as a “good cancer”; however, as someone who has seen the impact of thyroid cancer in a loved one, I firmly believe thyroid cancer is not a good cancer. Therefore, I feel responsible for advocating for thyroid cancer patients, which has resulted in my career in quality improvement initiatives and educational opportunities to raise awareness on thyroid cancer and endocrine tumors.
Can you elaborate on your dual training in Endocrinology and Oncology and how does that distinguish your role as a physician?
After practicing several years as an endocrinologist, to provide comprehensive care across all endocrine cancer stages, I subspecialized further at the prestigious advanced “Oncologic Endocrinology Fellowship” from the University of Texas MD Anderson Cancer Center. The dual training perspective has allowed me to care from patients from early-stage thyroid cancer at their initial diagnosis to advanced metastatic thyroid cancer, including treating with oral chemotherapy agents and immunotherapy, caring for patients with rare tumors including medullary thyroid carcinoma, anaplastic thyroid carcinoma, adrenal cancer, multiple endocrine neoplasia and pheochromocytoma/paraganglioma syndromes.
Your research interest includes the management and treatment of intermediate to high-risk thyroid cancers. Can you share therapies being administered to patients with aggressive tumors?
Most thyroid cancers are treated with thyroidectomy, thyroid hormone replacement at specific TSH targets (better known as TSH suppression), and selective use of radioactive iodine. However, a subset of cases may develop metastatic disease resistant to radioactive iodine or present with an aggressive variant including poorly differentiated thyroid cancer or anaplastic thyroid cancer (ATC). At present, there are several oral multikinase inhibitors, including Lenvatinib, sorafenib, and cabozantinib; however, as the field of precision oncology is actively evolving, newer targeted therapies have emerged. For example, an improvement in the overall survival of patients with anaplastic thyroid cancer whose tumors are driven by a BRAF V600E alteration has been evidenced with the oral combination treatment of dabrafenib and trametinib. For the management of advanced medullary thyroid carcinoma (MTC), initially, only two multikinase inhibitors had been approved, Cabozantinib and Vandetanib. Recently, two new therapies for RET altered MTC or advanced thyroid cancer with a RET fusion gene alteration, selpercatinib and pralsetinib, have shown significant responses with tolerable side effect profiles. Similarly, other oral targeted therapies have been identified as options for tumors with NTRK fusions, ALK fusions, or ROS fusions. In addition, the era of precision oncology with targeted therapies has opened the door to novel neoadjuvant approaches that facilitate less extensive surgeries and redifferentiation of tumors to recapture the ability to receive radioactive iodine therapy. Finally, incorporating immunotherapy for certain aggressive tumors like anaplastic thyroid carcinoma provides another potential management option. As an endocrine oncologist, identifying patients at risk of needing advanced therapies early on is vital, and the appropriate timing to incorporate these therapies & side effect management to provide the best possible balance between cancer care and quality of life.
As a bilingual oncologist, in what ways has your work impacted the Hispanic community?
As an underrepresented minority in medicine and one of the few certified oncologic endocrinologists in the nation, I feel the responsibility, duty, and passion of communicating the knowledge received to the global medical community, future healthcare generations, and the general public. Providing clinical care to the Hispanic community in their primary language and opportunities to make a difference in education via lectures, conferences, and media appearances in Spanish has been very rewarding throughout my career.
What do you envision for the future of Endocrine Oncology at Moffitt?
Endocrine Oncology at Moffitt will continue moving forward by expanding patient-centered multidisciplinary care of excellence combined with educational initiatives, cutting-edge research, and novel therapeutic approaches.
To learn more about Endocrine related cancers, please reach out to a member of our Endocrine Oncology Program. To refer a patient to Moffitt Cancer Center, call 1-888-663-3488, complete the online form or contact a physician liaison for assistance.