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ESMO E-Learning: New Systemic Treatment Options for Radioiodine-Refractory Differentiated and Medullary Thyroid Cancers

Learning objectives

  1. To better understand the genetic landscape of different subtypes of thyroid cancer
  2. To provide an overview of the current treatment options for patients with differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC)
  3. To improve the knowledge about emerging drugs for the treatment of patients with DTC and MTC


Thyroid cancer accounts for only 1% of all diagnosed tumours in adults. Differentiated thyroid cancer (DTC) represents more than 90% of all thyroid cancers, while medullary thyroid cancer (MTC) and anaplastic thyroid cancer are significantly less frequent. Although thyroid cancer is a heterogeneous disease, the advances in the understanding of the genomic landscape have helped to develop novel drugs in recent years.

In this E-Learning module, the author provides an overview of the epidemiology​, histology​, details of molecular biology​, radioiodine refractoriness in DTC, and elaborates systemic treatment for RAI-DTC and MTC. ​

In thyroid cancer, some signaling pathways have shown potential therapeutic relevance. Multikinase inhibitors that block VEGFR signaling have demonstrated benefit in the management of DTC and MTC in phase III trials, such as sorafenib, lenvatinib, cabozantinib and vandetanib. Detailed results from key clinical trials are presented in the module.

The scenario of thyroid cancer treatment is rapidly changing with the emerging role of RET inhibitors, such as pralsetinib and selpercatinib​ and the author provides a detailed overview of the development of such inhibitors. 

Other promising targets are under investigation based on a better knowledge of the molecular biology of thyroid cancer and better understanding of the resistance mechanisms​.

Furthermore, the author provides an overview of clinical trials in patients with thyroid cancer in terms of testing NTRK inhibitors, entrectinib and larotrectinib. The module also covers the basics in terms of redifferentiation therapy, as kinase inhibitors have shown to re-induce iodide uptake in RAI-refractory thyroid cancer cells.

The author gives a comprehensive overview of investigational drugs, including a rationale for immunotherapy, as well as immunotherapy trials addressing thyroid cancer.

This E-Learning module was published in 2020 and expired in 2022.

Last update: 07 Aug 2020

The author has reported speaker, consultancy or advisory role for Ipsen, Pfizer, BMS and EISAI; Consultancy or advisory role for Roche, Sanofi, Bayer, Astellas, Janssen-Cilag, MSD. Financial support for work on Clinical Trials from Roche, Astra Zeneca, BMS, MSD, EISAI, Pfizer, Ipsen, GSK-Novartis, Clovis, Nektar Therapeutics, Janssen-Cilag, Astellas and Bayer. Project lead in kidney cancer: funding from Pfizer and Roche. Project lead in neuroendocrine tumours: funding from IPSEN.

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