Treatment Landscape for Patients with Advanced RAI-R-DTC
Marcia S. Brose, MD, PhD, discusses the frontline treatment landscape for patients with advanced RAI-R-DTC, focusing on sorafenib and the DECISION trial as well as lenvatinib and the SELECT trial.
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.
Anticipating Novel Options for the RAI-Refractory DTC Armamentarium
May 15th 2023In season 4, episode 6 of Targeted Talks, Warren Swegal, MD, takes a multidisciplinary look at the RAI-refractory differentiated thyroid cancer treatment landscape, including the research behind 2 promising systemic therapy options.
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