What Is the Treatment of Follicular Thyroid Cancer?
Follicular thyroid cancer (FTC) is a well-differentiated thyroid malignancy. When systemic therapy is required, treatment selection depends substantially on the tumor's molecular profile alongside standard clinical factors.
Clinical Scenario
This protocol addresses follicular thyroid cancer requiring systemic treatment — including cases where radioactive iodine is no longer effective. Molecular testing plays a central role in determining which therapeutic class is most appropriate.
Treatment Approach (Partial Overview)
The core approach involves multi-tyrosine kinase inhibitor therapy. However, when the tumor carries a specific identifiable molecular alteration, a distinct class of targeted agents may be preferred over standard multi-TKI options.
The complete regimen — including agent selection, molecular criteria, and sequencing — is available in the full protocol.
References
DOI: 10.1530/ETJ-24-0146
- Multi-tyrosine kinase inhibitors such as sorafenib and lenvatinib are utilized for treating RAI-refractory FTCs.
- Anti-angiogenic drugs are multikinase inhibitors, including sorafenib, lenvatinib, and cabozantinib.
- Targeted agents include selective RET inhibitors (selpercatinib or pralsetinib) for FTCs harboring RET fusions or RET mutations, NTRK inhibitors (entrectinib and larotrectinib) for FTCs with NTRK fusions, and the BRAF/MEK inhibitor combination (dabrafenib/trametinib) for FTCs with BRAF V600E mutations.
- Furthermore, pembrolizumab is considered for FTCs with a tumor mutational burden.