Challenges in the management of advanced thyroid carcinoma and advances in systemic therapies with Tyrosine Kinase Inhibitors

Abstract

Background. Although thyroid carcinoma is a disease with a good prognosis, forms refractory to radioactive iodine and poorly differentiated forms present challenges for clinicians. Studies indicate that these patients have median 5-year survival rates of 60% and 10% for metastatic forms. Objective(s). This review focuses on current treatment options in advanced thyroid cancer, summarizing advances in targeted therapies such as tyrosine kinase inhibitors and monoclonal antibodies. Materials and methods. A narrative review of the recent literature (2018-2024) on systemic treatment options for advanced thyroid cancer, including phase II and III clinical trials, international guidelines, and research, was performed, with the main sources being PubMed and UpToDate on targeted therapies, MABs, and specific molecular inhibitors. Results. Multi-targeted tyrosine kinase inhibitors, such as lenvatinib and sorafenib, increased progression-free survival (PFS) by an average of 18.3 months in 64.8% of patients and were approved by the FDA. Significant responses were also seen with RET inhibitors, BRAF/MEK, larotrectinib, according to the tumor molecular profile, showing the Objective(s). response of 79% with a PFS of 20.1 months. The problem with these is the limited indications for their use due to the need for in-depth study of genetic modulations in tumor tissue and positive results. s only in specific subgroups. Other preparations with promising results are in pre-clinical stages. Conclusion(s). Targeted therapies have revolutionized the management of patients with ACTs, leading to improved PFS, however, questions remain about the optimal time to initiate systemic treatment, the limitations of molecular analysis, and the high specificity of some drugs, but the outlook is promising.