Therapy of metastatic differentiated thyroid cancer refractory to standard treatment

TSH: thyroid-stimulating hormone; aaMKI: antiangiogenic multitargeted kinase inhibitor.
* When selecting patients for systemic treatment, emphasis should be placed on overall tumor burden or individual lesion location, growth trajectory, and potential for morbidity if disease progresses further.
¶ Clinical trial options are often dictated by the presence of specific gene mutations or signaling pathway abnormalities that are the targets of approved or investigational therapies.
Δ Typically, only a single mutation is "actionable."
◊ Contraindications to antiangiogenic kinase inhibitors may include major surgery within 28 days, active bleeding, untreated hemorrhagic brain metastases, encasement by tumor of major arteries such as the carotid, or arterial thromboembolic event within the last 6 to 12 months. We also try to minimize use of potent antiangiogenic agents in patients with prior external beam radiotherapy to the neck due to reports of tracheoesophageal fistulas.