Pharmacotherapeutic options for radioiodine-refractory differentiated thyroid cancer. Update 2019

BackgroundBased on international guidelines from the American and British Thyroid Association we are aiming for arisk-adapted individualized therapy concept also in advanced radioiodine refractory differentiated thyroid cancer (DTC).ResultsThe use of systemic molecularly targeted therapy should be limited to patients with large tumor burden and progressive, metastastic disease that is not amenable to other local palliative approaches or awatch and wait strategy. In addition to the two approved tyrosine kinase inhibitors (TKI), lenvatinib and sorafenib, there are avariety of other TKI (such as cabozantinib, pazopanib, sunitinib, axitinib) as well as selective inhibitors (everolimus, dabrafenib +/- trametinib, vemurafenib, tropomyosin receptor kinase (TRK) and RET inhibitors) available within clinical trials or for off-label use in an individualized treatment approach taking into consideration patient characteristics, such as age, co-morbidities, patient preference, as well tumor characateristics. Of high potential is also the possibility to reestablish radioiodine therapy by reinduction of radioiodine uptake via BRAF inhibition and/or MEK inhibition, that is currently being evaluated in several clinical trials.ConclusionTo be able to exploit all molecularly targeted therapeutic options in an individualized manner, early molecular analysis of tumor tissue is highly recommended. Patients with advanced radioiodine refractory DTC should be referred to experienced centers that can offer interdisciplinary expertise in the individualization of treatment and participation in therapeutic trials.