Systemic Therapeutic Options in Radioiodine-Refractory Differentiated Thyroid Cancer: Current Indications and Optimal...

Area of Science:

• Oncology
• Endocrinology
• Cancer Research

Background:

• Thyroid cancer (TC) is a common malignancy, with differentiated thyroid carcinoma (DTC) having a good prognosis after surgery and radioiodine (RAI) ablation.
• A subset of 5-15% of patients develop RAI-refractory (RAI-R) disease, associated with poorer outcomes.
• Treatment for RAI-R TC is guided by disease progression, ranging from active surveillance to systemic therapies.

Purpose of the Study:

• To review current evidence and clinical guidelines for managing RAI-refractory differentiated thyroid cancer.
• To discuss the role of systemic therapies, including multikinase inhibitors (MKIs) and novel targeted agents.
• To highlight challenges in treatment timing and toxicity management to optimize patient quality of life.

Main Methods:

• Literature review of current evidence on RAI-R TC management.
• Synthesis of clinical guidelines from organizations like ATA and ESMO.
• Analysis of systemic therapy options, including MKIs and emerging targeted treatments.

Main Results:

• First-line systemic therapy for progressive RAI-R TC includes MKIs like lenvatinib and sorafenib; cabozantinib is approved for resistant cases.
• Novel therapies targeting RET, NTRK, and immune checkpoints are under investigation.
• Balancing progression-free survival benefits against MKI toxicities is a key challenge impacting quality of life.

Conclusions:

• Optimal timing for systemic therapy in RAI-R TC is critical, considering disease progression and patient status.
• Molecular testing can guide personalized therapy selection.
• A multidisciplinary approach and careful toxicity monitoring are essential for managing RAI-R TC and maintaining quality of life.