Overview of Radioiodine-Refractory Differentiated Thyroid Cancer (RAI-R-DTC)

EP: 1.Patient Profile: A 43-Year-Old Man with RAI-R-DTC

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EP: 2.Overview of Radioiodine-Refractory Differentiated Thyroid Cancer (RAI-R-DTC)

EP: 3.Treatment Landscape for Patients with Advanced RAI-R-DTC

EP: 4.Standard-of-Care Treatment for Patients with Advanced RAI-R-DTC

EP: 5.Treatment Selection for Patients With RAI-R-DTC

EP: 6.Lenvatinib Treatment Considerations in RAI-R-DTC

EP: 7.Data on Age and Randomization of Dose in Patients with RAI-R-DTC

EP: 8.Treatment Sequencing and Advice for Community Oncologists Treating RAI-R-DTC

Case: A 43-Year-Old Man with RAI-R-DTC

Initial presentation and initial treatment:

• A 43-year-old man presents with fatigue, neck pain and dysphagia and was diagnosed with papillary thyroid carcinoma 10 years ago
• Following a total thyroidectomy, he underwent multiple rounds of radioactive ablation therapy.
• Initial response was positive with undetectable thyroid globulin levels and negative imaging
• PMH: Hyperlipidemia; Hypertension; Diabetes (controlled with medications)
• SH: lives with his wife and 2 teenage children; non-smoker and drinks alcohol occasionally
• PE: appears fatigued with a palpable thyroid nodule in the left lobe
• Neck examination: palpable mass in the left neck, and cervical lymphadenopathy

Clinical workup

• Labs: WNL
• Neck ultrasound: Identifies a large, irregular mass in the left thyroid bed with invasion into surrounding structures.
• CT of the neck and chest revealed neck mass along with multiple pulmonary nodules, largest 2cm x 1.5cm
• TSH: Within normal limits
• Thyroglobulin levels: Markedly elevated
• Radioactive iodine scan: Confirms radioiodine refractory disease with widespread involvement of cervical lymph nodes and distant metastases.
• Needle biopsy was performed which confirmed Papillary thyroid cancer. Next-generation sequencing was negative for mutations, rearrangements

Subsequent treatment and follow-up

• Lenvatinib 24mg po qd was initiated

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Marcia S. Brose, MD, PhD.

Brose discusses the prevalence of radioiodine-refractory differentiated thyroid cancer (RAI-R-DTC), which occurs in approximately 15% of patients, particularly those with distant metastases at diagnosis and older age. She emphasizes the importance of patient awareness regarding the possibility of RAI-refractory disease. Although the majority of DTC patients do not have metastatic disease and some young women with metastatic disease may be cured with RAI alone, Brose’s experience shows that RAI-refractory DTC is highly treatable with multikinase inhibitors.

Patients with RAI-refractory DTC often present with a nodule after a period of stability, and further workup reveals multiple lung metastases. Serial CT scans may show minimal change over time, suggesting slow growth of metastases, which can develop over a decade. The lung metastases typically appear well-demarcated with smooth edges and a round shape on CT scans, a hallmark of the slow-growing nature of thyroid cancer. Patients usually present due to a palpable mass or, occasionally, symptoms such as difficulty swallowing.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.