Cytotoxic chemotherapy for differentiated thyroid carcinoma

For patients with metastatic differentiated thyroid carcinoma that progresses despite standard therapies, systemic cytotoxic chemotherapy has traditionally been a limited option. Historically, phase II studies and small retrospective series have failed to identify highly effective drugs or regimens, in part by failing to recruit sufficient numbers of patients. Doxorubicin remains the single most effective cytotoxic chemotherapy for the treatment of metastatic disease, although complete responses are rare, partial responses limited and toxicity considerable. Newer agents, such as pemetrexed, may be of benefit and potentially better tolerated. Newer approaches to treatment as well as trial design and recruitment, emphasising the role of thyroid cancer patients in early drug trials, may yield advances in patient benefit.