Thyroid Carcinoma

Question 1

Systemic Therapy for Differentiated Thyroid Cancer

Answer 1

ie Papillary, Follicular, or Oncocytic

Preferred: Lenvatinib

Other options: Sorafenib

Special Circumstances:
Cabozantinib (CABOMETYX) if progression after lenvatinib and/or sorafenib

Larotrectinib or entrectinib for patients with NTRK gene

Selpercatinib or pralsetinib for patients with RET gene fusion‐positive tumors

Pembrolizumab for patients with TMB-H (≥10 mut/Mb) tumors or for patients with MSI‐H or dMMR tumors that have progressed following prior treatment with no satisfactory alternative options

Dabrafenib/trametinib for patients with BRAF V600E mutation that has progressed following prior treatment with no satisfactory alternative treatment options

Question 2

Systemic Therapy for Medullary Thyroid Cancer

Answer 2

Preferred Regimens:
Vandetanib
Cabozantinib (COMETRIQ)
Selpercatinib (RET mutation‐positive)
Pralsetinib (RET mutation‐positive)

Useful in Certain Circumstances:
Pembrolizumab (TMB-H [≥10 mut/Mb] or for patients with MSI‐H or dMMR tumors that have progressed following prior treatment with no satisfactory alternative options)