Advances in Radioactive Iodine-Refractory Differentiated Thyroid Cancer

Patients with radioactive iodine-refractory thyroid cancer (RAIR-DTC) have poor prognoses and, until recently, there were no effective targeted systemic therapies available for RAIR-DTC. Targeted therapies sorafenib and lenvatinib have been approved by the FDA for treating RAIR-DTC in the last 5 years. Along with these approved therapies, other targeted therapies, such as cabozantinib and vandetanib, which were approved earlier in the decade by the FDA for treating medullary thyroid cancer, are currently in DTC clinical trials. Systemic treatment that balances toxicity with efficacy remains an unmet need in this patient population, which can include patients with relatively long life-expectancies necessitating treatment regimens with extended durations. Targeted therapies hold great promise, but due to the rarity of advanced thyroid cancer, large-scale international clinical trials are needed to determine the best management strategies. Along with reviewing current and developmental therapies for RAIR-DTC, this program will address strategies to match patients to optimal treatments and review that optimal management of side effects is critical.