Targeted Systemic Therapy in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer
With the common use of imaging modalities such as ultrasonography (USG), the incidence of thyroid cancer has increased in recent years. Most of the thyroid cancers are differentiated thyroid cancers (DTC). In the case of DTC, the ability of cancer cells to concentrate iodine makes radioactive iodine (RAI) therapy possible, which is an effective treatment for DTCs. Surgical operation and RAI treatment give a chance to be cured for many thyroid cancer patients. Nonetheless, resistance to RAI treatment develops in a group of patients, and the prognosis worsens. In RAI-refractory (RAI-R) DTC patients, chemotherapeutic drugs such as doxorubicin and cisplatin have been tried, but no successful results have been obtained. In contrast, multiple kinase inhibitors (MKIs) have provided for RAI-R patients a new treatment option. Sorafenib and lenvatinib have been approved by the FDA for RAI-R DTC patients, and phase studies of other MKIs are ongoing.
In addition to offering a new opportunity for RAI-R patients with reduced treatment options, side effect profile creates difficulties in clinical practice. These side effects can affect the patients’ quality of life. For these reasons, treatment of MKIs should be considered in significantly symptomatic patients with rapid progression rather than those with minimal progression or stable, symptom-free patients. Treatment decision should be made by considering patient-based profit-loss rates.
KeywordsDTC RAI-refractory RAI-R Tyrosine kinase inhibitors TKI Multiple kinase inhibitors MKI Sorafenib Lenvatinib
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