Treatment Landscape for Patients with Advanced RAI-R-DTC

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

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

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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 reviews the current treatment landscape for patients with radioiodine-refractory differentiated thyroid cancer (RAI-R-DTC) in the frontline setting. Two drugs are currently approved by the FDA: sorafenib, approved in 2012 based on the DECISION trial, and lenvatinib, approved in 2014 based on the SELECT trial. Both agents primarily work as VEGF receptor inhibitors, targeting newly forming blood vessels that cancer cells depend on for growth.

The DECISION trial showed a low response rate (around 10%) with sorafenib but an improvement in progression-free survival from 5.8 months to 10.8 months. Lenvatinib demonstrated a higher response rate (up to 60%) but also a higher incidence of grade 3 or higher adverse events, particularly blood pressure elevations, suggesting it is a more potent inhibitor. Both agents are efficacious and safe, but close follow-up with a physician is essential for monitoring and managing toxicities, such as elevated blood pressure and hand-foot skin reactions.

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