The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Abstract

Until recently, patients with advanced thyroid cancers had limited options for systemic treatment. With the introduction of tyrosine kinase inhibitors (TKIs) as a promising new class of targeted therapies for thyroid cancer, suddenly patients with advanced disease were given new options to extend survival. Guidelines worldwide have been updated to include general indications for these newer agents, but questions remain regarding which agent(s) to select, when to begin treatment, and how long therapy should continue. Additionally, the true impact of TKIs on overall survival and quality-of-life in thyroid cancer patients needs further clarification. As familiarity with approved agents and longer-term data become available, better strategies for implementation of these targeted drugs will evolve to optimize benefit for patients living with metastatic disease.

Novel Therapies Against Aggressive Differentiated Thyroid Carcinomas

“…Dabrafenib was well tolerated, with no patient requiring dose reduction even in long-term treatment [28][29][50][51].…”

“…Severe AEs were noted in 65 and 68% of the two groups, respectively, [29,48] with 22% developing cutaneous squamous cell carcinoma [28,30].…”

“…Efficacy of tyrosine kinase inhibitors in TC Tyrosine kinase inhibitors (TKIs) are increasingly being used in advanced and RAIRTC, for which the therapeutic options have been limited for decades. Two TKIs are currently approved for advanced TC, others being used off-label based on the results of Phase II trials [27,29] and some are being studied in Phase I, II or III [27,[33][34].…”

“…Vemurafenib and dabrafenib are small inhibitors highly selective to the BRAF-V600E mutations, which are being studied in Phase II trials [27][28][29][30].…”

“…Vemurafenib was efficient in some BRAFV600E-positive advanced RAIRTC patients (partial responses of 35-38.5% in naive patients and 26-29% in those previously exposed to a VEGFR inhibitor) [29][30][48][49]. Severe AEs were noted in 65 and 68% of the two groups, respectively, [29,48] with 22% developing cutaneous squamous cell carcinoma [28,30].…”