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Section editor transclusions Note: these are regimens tested in histology-specific populations, please see the main thyroid cancer page for other regimens.

11 regimens on this page 14 variants on this page

Guidelines

ATA

2015: Guidelines on the management of thyroid nodules and differentiated thyroid cancer PubMed

ESMO

2019: Filetti et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Older

2012: Pacini et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed

NCCN

NCCN Guidelines - Thyroid Carcinoma

All lines of therapy

Cabozantinib monotherapy

Regimen variant #1, pediatric dosing

FDA-recommended dose

Note: this is the FDA-recommended dose in pediatric patients who are 12 years of age or older with BSA less than 1.2 m².

Targeted therapy

Cabozantinib (Cometriq) 40 mg PO once per day

Continued indefinitely

Regimen variant #2

FDA-recommended dose

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Brose et al. 2021 (COSMIC-311)	2019-2020	Phase 3 (E-RT-esc)	Placebo	Superior PFS Median PFS: NYR vs 1.9 mo (HR 0.22, 96% CI 0.13-0.36)

Note: this is the FDA-recommended dose for adult patients.

Targeted therapy

Cabozantinib (Cometriq) 60 mg PO once per day

Continued indefinitely

References

COSMIC-311: Brose MS, Robinson B, Sherman SI, Krajewska J, Lin CC, Vaisman F, Hoff AO, Hitre E, Bowles DW, Hernando J, Faoro L, Banerjee K, Oliver JW, Keam B, Capdevila J. Cabozantinib for radioiodine-refractory differentiated thyroid cancer (COSMIC-311): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2021 Aug;22(8):1126-1138. Epub 2021 Jul 5. link to original article contains dosing details in manuscript PubMed NCT03690388

Lenvatinib monotherapy

Regimen

Study

Years of enrollment

Evidence

Comparator

Comparative Efficacy

Schlumberger et al. 2015 (SELECT)

ESMO-MCBS (2)

2011-2012

Phase 3 (E-RT-esc)

Placebo

Superior PFS
Median PFS: 18.3 vs 3.6 mo
(HR 0.21, 99% CI 0.14-0.31)

Zheng et al. 2021 (E7080-C086-308)

2017-NR

Phase 3 (E-esc)

Placebo

Superior PFS
Median PFS: 23.9 vs 3.7 mo
(HR 0.16, 95% CI 0.10-0.26)

Targeted therapy

Lenvatinib (Lenvima) 24 mg PO once per day
- Per the package insert, patients with eGFR of less than 30 mL/min/1.73m² by Cockroft-Gault or Child-Pugh C severe hepatic impairment should receive 14 mg PO once per day

28-day cycles

References

SELECT: Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. link to original article contains dosing details in abstract PubMed NCT01321554
E7080-C086-308: Zheng X, Xu Z, Ji Q, Ge M, Shi F, Qin J, Wang F, Chen G, Zhang Y, Huang R, Tan J, Huang T, Li S, Lv Z, Lin Y, Guo Z, Kubota T, Suzuki T, Ikezawa H, Gao M. A Randomized, Phase III Study of Lenvatinib in Chinese Patients with Radioiodine-Refractory Differentiated Thyroid Cancer. Clin Cancer Res. 2021 Oct 15;27(20):5502-5509. Epub 2021 Jul 29. link to original article contains dosing details in abstract PubMed NCT02966093

Pazopanib monotherapy

Regimen

Study	Years of enrollment	Evidence
Bible et al. 2010 (MC057H)	2008-2009	Phase 2

Targeted therapy

Pazopanib (Votrient) 800 mg PO once per day

28-day cycles

References

MC057H: Bible KC, Suman VJ, Molina JR, Smallridge RC, Maples WJ, Menefee ME, Rubin J, Sideras K, Morris JC 3rd, McIver B, Burton JK, Webster KP, Bieber C, Traynor AM, Flynn PJ, Goh BC, Tang H, Ivy SP, Erlichman C; Endocrine Malignancies Disease Oriented Group; Mayo Clinic Cancer Center; Mayo Phase 2 Consortium. Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study. Lancet Oncol. 2010 Oct;11(10):962-72. Epub 2010 Sep 17. link to original article contains dosing details in abstract link to PMC article PubMed NCT00625846

Placebo

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Leboulleux et al. 2012 (D4200C00079)	2007-2008	Randomized Phase 2 (C)	Vandetanib	Inferior PFS
Brose et al. 2014 (DECISION)	2009-2011	Phase 3 (C)	Sorafenib	Inferior PFS
Schlumberger et al. 2015 (SELECT)	2011-2012	Phase 3 (C)	Lenvatinib	Inferior PFS
Brose et al. 2021 (COSMIC-311)	2019-2020	Phase 3 (C)	Cabozantinib	Inferior PFS

No active antineoplastic treatment.

References

D4200C00079: Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. link to original article contains dosing details in abstract PubMed NCT00537095
DECISION: Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ; DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014 Jul 26;384(9940):319-28. Epub 2014 Apr 24. link to original article link to PMC article PubMed NCT00984282
SELECT: Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. link to original article PubMed NCT01321554
COSMIC-311: Brose MS, Robinson B, Sherman SI, Krajewska J, Lin CC, Vaisman F, Hoff AO, Hitre E, Bowles DW, Hernando J, Faoro L, Banerjee K, Oliver JW, Keam B, Capdevila J. Cabozantinib for radioiodine-refractory differentiated thyroid cancer (COSMIC-311): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2021 Aug;22(8):1126-1138. Epub 2021 Jul 5. link to original article contains dosing details in manuscript PubMed NCT03690388

Radioiodine ablation

Regimen variant #1, 1.1 GBq

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Schlumberger et al. 2012 (ESTIMABL1)	2007-2010	Phase 3 (E-de-esc)	I-131; 3.7 GBq	Equivalent rate of ablation
Mallick et al. 2012 (HiLo)	2007-2010	Phase 3 (E-de-esc)	I-131; 3.7 GBq	Non-inferior rate of ablation
Leboulleux et al. 2022 (ESTIMABL2)	2013-2017	Phase 3 (C)	Observation	Non-inferior composite endpoint

Preceding treatment

Thyroidectomy

Radiotherapy

Iodine-131 1.1 GBq

One course

Regimen variant #2, 3.7 GBq

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Schlumberger et al. 2012 (ESTIMABL1)	2007-2010	Phase 3 (C)	I-131; 1.1 GBq	Equivalent outcome
Mallick et al. 2012 (HiLo)	2007-2010	Phase 3 (C)	I-131; 1.1 GBq	Non-inferior rate of ablation
Ho et al. 2022 (ASTRA)	2013-2016	Phase 3 (C)	RAI & Selumetinib	Did not meet primary endpoint of CR rate at 18 months

Preceding treatment

Thyroidectomy

Radiotherapy

Iodine-131 3.7 GBq

One course

Regimen variant #3, variable

Study	Years of enrollment	Evidence
Maxon et al. 1983	NR in abstract	Non-randomized

Note: "The amount of 131I administered was arbitrarily determined by whoever was treating the patient"; included here for historic reference only.

Preceding treatment

Thyroidectomy

Radiotherapy

Iodine-131

References

Case report: Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy; effect on functioning metastases of adenocarcinoma of the thyroid. J Am Med Assoc. 1946 Dec 7;132(14):838-47. link to original article PubMed
Maxon HR, Thomas SR, Hertzberg VS, Kereiakes JG, Chen IW, Sperling MI, Saenger EL. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med. 1983 Oct 20;309(16):937-41. link to original article PubMed
SYTJ001T/2000: Mäenpää HO, Heikkonen J, Vaalavirta L, Tenhunen M, Joensuu H. Low vs. high radioiodine activity to ablate the thyroid after thyroidectomy for cancer: a randomized study. PLoS One. 2008 Apr 2;3(4):e1885. link to original article link to PMC article PubMed NCT00115895
1. Update: Ahtiainen V, Vaalavirta L, Tenhunen M, Joensuu H, Mäenpää H. Randomised comparison of 1.1 GBq and 3.7 GBq radioiodine to ablate the thyroid in the treatment of low-risk thyroid cancer: a 13-year follow-up. Acta Oncol. 2020 Sep;59(9):1064-1071. Epub 2020 Jun 30. link to original article PubMed
ESTIMABL1: Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, Bardet S, Leenhardt L, Bastie D, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Bonichon F, Dejax C, Toubert ME, Leboulleux S, Ricard M, Benhamou E; Tumeurs de la Thyroïde Refractaires Network for the Essai Stimulation Ablation Equivalence Trial. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med. 2012 May 3;366(18):1663-73. link to original article PubMed NCT00435851
1. Update: Schlumberger M, Leboulleux S, Catargi B, Deandreis D, Zerdoud S, Bardet S, Rusu D, Godbert Y, Buffet C, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Toubert ME, Kelly A, Benhamou E, Borget I. Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial. Lancet Diabetes Endocrinol. 2018 Aug;6(8):618-626. Epub 2018 May 26. link to original article PubMed
HiLo: Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, Nicol A, Clark PM, Farnell K, McCready R, Smellie J, Franklyn JA, John R, Nutting CM, Newbold K, Lemon C, Gerrard G, Abdel-Hamid A, Hardman J, Macias E, Roques T, Whitaker S, Vijayan R, Alvarez P, Beare S, Forsyth S, Kadalayil L, Hackshaw A. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med. 2012 May 3;366(18):1674-85. link to original article contains dosing details in abstract PubMed NCT00415233
ASTRA: Ho AL, Dedecjus M, Wirth LJ, Tuttle RM, Inabnet WB 3rd, Tennvall J, Vaisman F, Bastholt L, Gianoukakis AG, Rodien P, Paschke R, Elisei R, Viola D, So K, Carroll D, Hovey T, Thakre B, Fagin JA; ASTRA investigator group. Selumetinib Plus Adjuvant Radioactive Iodine in Patients With High-Risk Differentiated Thyroid Cancer: A Phase III, Randomized, Placebo-Controlled Trial (ASTRA). J Clin Oncol. 2022 Jun 10;40(17):1870-1878. Epub 2022 Feb 22. link to original article contains dosing details in abstract PubMed NCT01843062
ESTIMABL2: Leboulleux S, Bournaud C, Chougnet CN, Zerdoud S, Al Ghuzlan A, Catargi B, Do Cao C, Kelly A, Barge ML, Lacroix L, Dygai I, Vera P, Rusu D, Schneegans O, Benisvy D, Klein M, Roux J, Eberle MC, Bastie D, Nascimento C, Giraudet AL, Le Moullec N, Bardet S, Drui D, Roudaut N, Godbert Y, Morel O, Drutel A, Lamartina L, Schvartz C, Velayoudom FL, Schlumberger MJ, Leenhardt L, Borget I. Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer. N Engl J Med. 2022 Mar 10;386(10):923-932. link to original article contains dosing details in abstract PubMed NCT01837745

Radioiodine & Selumetinib

Regimen

Study	Years of enrollment	Evidence
Ho et al. 2013 (MSK 09-048)	2010-2011	Non-randomized

Radiotherapy

Iodine-131

Targeted therapy

Selumetinib (Koselugo)

References

MSK 09-048: Ho AL, Grewal RK, Leboeuf R, Sherman EJ, Pfister DG, Deandreis D, Pentlow KS, Zanzonico PB, Haque S, Gavane S, Ghossein RA, Ricarte-Filho JC, Domínguez JM, Shen R, Tuttle RM, Larson SM, Fagin JA. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med. 2013 Feb 14;368(7):623-32. link to original article link to PMC article PubMed NCT00970359

Sorafenib monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Brose et al. 2014 (DECISION)	2009-2011	Phase 3 (E-RT-esc)	Placebo	Superior PFS

Targeted therapy

Sorafenib (Nexavar) 400 mg PO twice per day

Continued indefinitely

References

DECISION: Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ; DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014 Jul 26;384(9940):319-28. Epub 2014 Apr 24. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00984282

Vandetanib monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Leboulleux et al. 2012 (D4200C00079)	2007-2008	Randomized Phase 2 (E-esc)	Placebo	Superior PFS

Targeted therapy

Vandetanib (Caprelsa) 300 mg PO once per day

Continued indefinitely

References

D4200C00079: Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. link to original article contains dosing details in abstract PubMed NCT00537095

Advanced or metastatic disease

Apatinib monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Lin et al. 2022 (REALITY)	2017-2020	Phase 3 (E-esc)	Placebo	Seems to have superior OS Median OS: NYR vs 29.9 mo (HR 0.42, 95% CI 0.18-0.97)

Targeted therapy

Apatinib (Aitan) 500 mg PO once per day

28-day cycles

References

REALITY: Lin Y, Qin S, Li Z, Yang H, Fu W, Li S, Chen W, Gao Z, Miao W, Xu H, Zhang Q, Zhao X, Bao J, Li L, Ren Y, Lin C, Jing S, Ma Q, Liang J, Chen G, Zhang H, Zhang Y, Zhou X, Sang Y, Hou Z. Apatinib vs Placebo in Patients With Locally Advanced or Metastatic, Radioactive Iodine-Refractory Differentiated Thyroid Cancer: The REALITY Randomized Clinical Trial. JAMA Oncol. 2022 Feb 1;8(2):242-250. link to original article link to PMC article contains dosing details in manuscript PubMed NCT03048877

Axitinib monotherapy

Regimen

Study	Years of enrollment	Evidence
Locati et al. 2014 (A4061027)	2006-2008	Phase 2

Targeted therapy

Axitinib (Inlyta) 5 mg PO twice per day

Continued indefinitely

References

A4061027: Locati LD, Licitra L, Agate L, Ou SH, Boucher A, Jarzab B, Qin S, Kane MA, Wirth LJ, Chen C, Kim S, Ingrosso A, Pithavala YK, Bycott P, Cohen EE. Treatment of advanced thyroid cancer with axitinib: Phase 2 study with pharmacokinetic/pharmacodynamic and quality-of-life assessments. Cancer. 2014 Sep 1;120(17):2694-703. Epub 2014 May 20. link to original article contains dosing details in manuscript PubMed NCT00389441

Sunitinib monotherapy

Regimen

Study	Years of enrollment	Evidence	Efficacy
Carr et al. 2010	2007-2009	Phase 2	ORR: 31% (95% CI: 16-47)

Targeted therapy

Sunitinib (Sutent) 37.5 mg PO once per day

Continued indefinitely

References

Carr LL, Mankoff DA, Goulart BH, Eaton KD, Capell PT, Kell EM, Bauman JE, Martins RG. Phase II study of daily sunitinib in FDG-PET-positive, iodine-refractory differentiated thyroid cancer and metastatic medullary carcinoma of the thyroid with functional imaging correlation. Clin Cancer Res. 2010 Nov 1;16(21):5260-8. Epub 2010 Sep 16. link to original article contains dosing details in manuscript link to PMC article PubMed

@@ Line 14: / Line 14: @@
 ==[https://www.thyroid.org/ ATA]==
 *'''2015:''' Guidelines on the management of thyroid nodules and differentiated thyroid cancer [https://pubmed.ncbi.nlm.nih.gov/28114862 PubMed]
 ==[http://www.esmo.org/ ESMO]==
 *'''2019:''' Filetti et al. [https://doi.org/10.1093/annonc/mdz400 Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up]
 ===Older===
 *'''2012:''' Pacini et al. [http://annonc.oxfordjournals.org/content/23/suppl_7/vii110.full.pdf+html Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/22997443 PubMed]
 ==[https://www.nccn.org/ NCCN]==
 *[https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf NCCN Guidelines - Thyroid Carcinoma]
 =All lines of therapy=
 ==Cabozantinib monotherapy {{#subobject:1dgac6|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, pediatric dosing {{#subobject:1gacnd|Variant=1}}===
 {| class="wikitable" style="color:white; background-color:#404040"
@@ Line 32: / Line 29: @@
 |}
 ''Note: this is the FDA-recommended dose in pediatric patients who are 12 years of age or older with BSA less than 1.2 m<sup>2</sup>.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Cabozantinib (Cometriq)]] 40 mg PO once per day
 '''Continued indefinitely'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2 {{#subobject:1hzndd|Variant=1}}===
 {| class="wikitable" style="color:white; background-color:#404040"
@@ Line 56: / Line 55: @@
 |}
 ''Note: this is the FDA-recommended dose for adult patients.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Cabozantinib (Cometriq)]] 60 mg PO once per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # '''COSMIC-311:''' Brose MS, Robinson B, Sherman SI, Krajewska J, Lin CC, Vaisman F, Hoff AO, Hitre E, Bowles DW, Hernando J, Faoro L, Banerjee K, Oliver JW, Keam B, Capdevila J. Cabozantinib for radioiodine-refractory differentiated thyroid cancer (COSMIC-311): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2021 Aug;22(8):1126-1138. Epub 2021 Jul 5. [https://doi.org/10.1016/s1470-2045(21)00332-6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/34237250/ PubMed] NCT03690388
 ==Lenvatinib monotherapy {{#subobject:PYR1|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:PYV1|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 74: / Line 73: @@
 |-
 |[https://doi.org/10.1056/NEJMoa1406470 Schlumberger et al. 2015 (SELECT)]
+{| class="wikitable" style="margin:auto; color:white; background-color:#1B4F26"
+|'''[https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-scorecards/scorecard-135-1 <span style="color:white;">ESMO-MCBS (2)</span>]'''
+|-
+|}
 |2011-2012
 | style="background-color:#1a9851" |Phase 3 (E-RT-esc)
@@ Line 86: / Line 89: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Lenvatinib (Lenvima)]] 24 mg PO once per day
 **Per the package insert, patients with eGFR of less than 30 mL/min/1.73m<sup>2</sup> by Cockroft-Gault or Child-Pugh C severe hepatic impairment should receive 14 mg PO once per day
 '''28-day cycles'''
+</div></div>
 ===References===
 <!-- # '''Abstract:''' Martin Schlumberger, Makoto Tahara, Lori J. Wirth, Bruce Robinson, Marcia S. Brose, Rossella Elisei, Corina E. Dutcus, Begoña de las Heras, Junming Zhu, Mouhammed Amir Habra, Kate Newbold, Manisha H. Shah, Ana O. Hoff, Andrew G Gianoukakis, Naomi Kiyota, Matthew Hiram Taylor, Sung-Bae Kim, Monika K Krzyzanowska, Steven I. Sherman. A phase 3, multicenter, double-blind, placebo-controlled trial of lenvatinib (E7080) in patients with 131I-refractory differentiated thyroid cancer (SELECT). 2014 ASCO Annual Meeting abstract LBA6008. [http://meetinglibrary.asco.org/content/132694-144 link to abstract] -->
 # '''SELECT:''' Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. [https://doi.org/10.1056/NEJMoa1406470 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/25671254 PubMed] NCT01321554
 #'''E7080-C086-308:''' Zheng X, Xu Z, Ji Q, Ge M, Shi F, Qin J, Wang F, Chen G, Zhang Y, Huang R, Tan J, Huang T, Li S, Lv Z, Lin Y, Guo Z, Kubota T, Suzuki T, Ikezawa H, Gao M. A Randomized, Phase III Study of Lenvatinib in Chinese Patients with Radioiodine-Refractory Differentiated Thyroid Cancer. Clin Cancer Res. 2021 Oct 15;27(20):5502-5509. Epub 2021 Jul 29. [https://doi.org/10.1158/1078-0432.ccr-21-0761 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/34326132/ PubMed] NCT02966093
 ==Pazopanib monotherapy {{#subobject:4ee26c|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:8faae3|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 111: / Line 112: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Pazopanib (Votrient)]] 800 mg PO once per day
 '''28-day cycles'''
+</div></div>
 ===References===
 # '''MC057H:''' Bible KC, Suman VJ, Molina JR, Smallridge RC, Maples WJ, Menefee ME, Rubin J, Sideras K, Morris JC 3rd, McIver B, Burton JK, Webster KP, Bieber C, Traynor AM,  Flynn PJ, Goh BC, Tang H, Ivy SP, Erlichman C; Endocrine Malignancies Disease Oriented Group; Mayo Clinic Cancer Center; Mayo Phase 2 Consortium. Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study. Lancet Oncol. 2010 Oct;11(10):962-72. Epub 2010 Sep 17. [https://doi.org/10.1016/s1470-2045(10)70203-5 link to original article] '''contains dosing details in abstract''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107731/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/20851682 PubMed] NCT00625846
 ==Placebo==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 154: / Line 154: @@
 |-
 |}
 ''No active antineoplastic treatment.''
+</div></div>
 ===References===
 # '''D4200C00079:''' Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. [https://doi.org/10.1016/S1470-2045(12)70335-2 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/22898678 PubMed] NCT00537095
@@ Line 163: / Line 162: @@
 # '''SELECT:''' Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, Habra MA, Newbold K, Shah MH, Hoff AO, Gianoukakis AG, Kiyota N, Taylor MH, Kim SB, Krzyzanowska MK, Dutcus CE, de las Heras B, Zhu J, Sherman SI. Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med. 2015 Feb 12;372(7):621-30. [https://doi.org/10.1056/NEJMoa1406470 link to original article] [https://pubmed.ncbi.nlm.nih.gov/25671254 PubMed] NCT01321554
 # '''COSMIC-311:''' Brose MS, Robinson B, Sherman SI, Krajewska J, Lin CC, Vaisman F, Hoff AO, Hitre E, Bowles DW, Hernando J, Faoro L, Banerjee K, Oliver JW, Keam B, Capdevila J. Cabozantinib for radioiodine-refractory differentiated thyroid cancer (COSMIC-311): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2021 Aug;22(8):1126-1138. Epub 2021 Jul 5. [https://doi.org/10.1016/s1470-2045(21)00332-6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/34237250/ PubMed] NCT03690388
 ==Radioiodine ablation {{#subobject:29fcfa|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 1.1 GBq {{#subobject:e834eb|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 193: / Line 191: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Thyroidectomy|Thyroidectomy]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[Iodine-131]] 1.1 GBq
 '''One course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 3.7 GBq {{#subobject:ca6380|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 226: / Line 228: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Thyroidectomy|Thyroidectomy]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[Iodine-131]] 3.7 GBq
 '''One course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, variable {{#subobject:75cca1|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 245: / Line 250: @@
 |}
 ''Note: "The amount of 131I administered was arbitrarily determined by whoever was treating the patient"; included here for historic reference only.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Thyroidectomy|Thyroidectomy]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[Iodine-131]]
+</div></div>
 ===References===
 # '''Case report:''' Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy; effect on functioning metastases of adenocarcinoma of the thyroid. J Am Med Assoc. 1946 Dec 7;132(14):838-47. [https://jamanetwork.com/journals/jama/article-abstract/290151 link to original article] [https://pubmed.ncbi.nlm.nih.gov/20274882 PubMed]
@@ Line 259: / Line 268: @@
 #'''ASTRA:''' Ho AL, Dedecjus M, Wirth LJ, Tuttle RM, Inabnet WB 3rd, Tennvall J, Vaisman F, Bastholt L, Gianoukakis AG, Rodien P, Paschke R, Elisei R, Viola D, So K, Carroll D, Hovey T, Thakre B, Fagin JA; ASTRA investigator group. Selumetinib Plus Adjuvant Radioactive Iodine in Patients With High-Risk Differentiated Thyroid Cancer: A Phase III, Randomized, Placebo-Controlled Trial (ASTRA). J Clin Oncol. 2022 Jun 10;40(17):1870-1878. Epub 2022 Feb 22. [https://doi.org/10.1200/jco.21.00714 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/35192411/ PubMed] NCT01843062
 #'''ESTIMABL2:''' Leboulleux S, Bournaud C, Chougnet CN, Zerdoud S, Al Ghuzlan A, Catargi B, Do Cao C, Kelly A, Barge ML, Lacroix L, Dygai I, Vera P, Rusu D, Schneegans O, Benisvy D, Klein M, Roux J, Eberle MC, Bastie D, Nascimento C, Giraudet AL, Le Moullec N, Bardet S, Drui D, Roudaut N, Godbert Y, Morel O, Drutel A, Lamartina L, Schvartz C, Velayoudom FL, Schlumberger MJ, Leenhardt L, Borget I. Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer. N Engl J Med. 2022 Mar 10;386(10):923-932. [https://doi.org/10.1056/nejmoa2111953 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/35263518/ PubMed] NCT01837745
 ==Radioiodine & Selumetinib {{#subobject:29y7ur|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:u8rq80|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 273: / Line 281: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[Iodine-131]]
 ====Targeted therapy====
 *[[Selumetinib (Koselugo)]]
+</div></div>
 ===References===
 # '''MSK 09-048:''' Ho AL, Grewal RK, Leboeuf R, Sherman EJ, Pfister DG, Deandreis D, Pentlow KS, Zanzonico PB, Haque S, Gavane S, Ghossein RA, Ricarte-Filho JC, Domínguez JM, Shen R, Tuttle RM, Larson SM, Fagin JA. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med. 2013 Feb 14;368(7):623-32. [https://doi.org/10.1056/NEJMoa1209288 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3615415/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/23406027 PubMed] NCT00970359
 ==Sorafenib monotherapy {{#subobject:36a6b4|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:237686|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 297: / Line 306: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Sorafenib (Nexavar)]] 400 mg PO twice per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # '''DECISION:''' Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Paschke R, Shong YK, Sherman SI, Smit JW, Chung J, Kappeler C, Peña C, Molnár I, Schlumberger MJ; DECISION investigators. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014 Jul 26;384(9940):319-28. Epub 2014 Apr 24. [https://doi.org/10.1016/s0140-6736(14)60421-9 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366116/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24768112 PubMed] NCT00984282
 ==Vandetanib monotherapy {{#subobject:83e502|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:d2f77d|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 321: / Line 330: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Vandetanib (Caprelsa)]] 300 mg PO once per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # '''D4200C00079:''' Leboulleux S, Bastholt L, Krause T, de la Fouchardiere C, Tennvall J, Awada A, Gómez JM, Bonichon F, Leenhardt L, Soufflet C, Licour M, Schlumberger MJ. Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trial. Lancet Oncol. 2012 Sep;13(9):897-905. Epub 2012 Aug 14. [https://doi.org/10.1016/S1470-2045(12)70335-2 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/22898678 PubMed] NCT00537095
 =Advanced or metastatic disease=
 ==Apatinib monotherapy {{#subobject:7hgub6|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:afjug7|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 348: / Line 355: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Apatinib (Aitan)]] 500 mg PO once per day
 '''28-day cycles'''
+</div></div>
 ===References===
 #'''REALITY:''' Lin Y, Qin S, Li Z, Yang H, Fu W, Li S, Chen W, Gao Z, Miao W, Xu H, Zhang Q, Zhao X, Bao J, Li L, Ren Y, Lin C, Jing S, Ma Q, Liang J, Chen G, Zhang H, Zhang Y, Zhou X, Sang Y, Hou Z. Apatinib vs Placebo in Patients With Locally Advanced or Metastatic, Radioactive Iodine-Refractory Differentiated Thyroid Cancer: The REALITY Randomized Clinical Trial. JAMA Oncol. 2022 Feb 1;8(2):242-250. [https://doi.org/10.1001/jamaoncol.2021.6268 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8678901/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/34913959/ PubMed] NCT03048877
 ==Axitinib monotherapy {{#subobject:73fcb6|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:aff447|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 369: / Line 375: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Axitinib (Inlyta)]] 5 mg PO twice per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # '''A4061027:''' Locati LD, Licitra L, Agate L, Ou SH, Boucher A, Jarzab B, Qin S, Kane MA, Wirth LJ, Chen C, Kim S, Ingrosso A, Pithavala YK, Bycott P, Cohen EE. Treatment of advanced thyroid cancer with axitinib: Phase 2 study with pharmacokinetic/pharmacodynamic and quality-of-life assessments. Cancer. 2014 Sep 1;120(17):2694-703. Epub 2014 May 20. [https://doi.org/10.1002/cncr.28766 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/24844950 PubMed] NCT00389441
 ==Sunitinib monotherapy {{#subobject:8d6c5|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:d1cea4|Variant=1}}===
 {| class="wikitable sortable" style="width: 80%; text-align:center;"
@@ Line 390: / Line 397: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Sunitinib (Sutent)]] 37.5 mg PO once per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 # Carr LL, Mankoff DA, Goulart BH, Eaton KD, Capell PT, Kell EM, Bauman JE, Martins RG. Phase II study of daily sunitinib in FDG-PET-positive, iodine-refractory differentiated thyroid cancer and metastatic medullary carcinoma of the thyroid with functional imaging correlation. Clin Cancer Res. 2010 Nov 1;16(21):5260-8. Epub 2010 Sep 16. [https://doi.org/10.1158/1078-0432.CCR-10-0994 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063514/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/20847059 PubMed]
 [[Category:Thyroid cancer regimens]]
 [[Category:Disease-specific pages]]
 [[Category:Endocrine cancers]]
 [[Category:Head and neck cancers]]

Difference between revisions of "Thyroid cancer, differentiated"

Revision as of 17:33, 13 February 2023

Guidelines

ATA

ESMO

Older

NCCN

All lines of therapy

Cabozantinib monotherapy

Regimen variant #1, pediatric dosing

Targeted therapy

Regimen variant #2

Targeted therapy

References

Lenvatinib monotherapy

Regimen

Targeted therapy

References

Pazopanib monotherapy

Regimen

Targeted therapy

References

Placebo

Regimen

References

Radioiodine ablation

Regimen variant #1, 1.1 GBq

Preceding treatment

Radiotherapy

Regimen variant #2, 3.7 GBq

Preceding treatment

Radiotherapy

Regimen variant #3, variable

Preceding treatment

Radiotherapy

References

Radioiodine & Selumetinib

Regimen

Radiotherapy

Targeted therapy

References

Sorafenib monotherapy

Regimen

Targeted therapy

References

Vandetanib monotherapy

Regimen

Targeted therapy

References

Advanced or metastatic disease

Apatinib monotherapy

Regimen

Targeted therapy

References

Axitinib monotherapy

Regimen

Targeted therapy

References

Sunitinib monotherapy

Regimen

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References

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