Treatment of Follicular Thyroid Cancer in Widely Invasive Follicular Thyroid Carcinoma
Widely invasive follicular thyroid carcinoma (FTC) is a high-risk presentation carrying a significantly worse prognosis than its minimally invasive counterpart. This clinical scenario calls for a structured, protocol-driven treatment approach.
This protocol addresses patients with widely invasive follicular thyroid carcinoma — a subtype associated with substantially higher rates of distant and local metastasis. Due to its poorer prognosis, clinical practice guidelines strongly recommend completion total thyroidectomy combined with radioactive iodine (RAI) therapy to detect and monitor metastatic spread in this population.
Treatment Approach
Systemic therapy in this setting involves multi-tyrosine kinase inhibitor therapy. For tumors with certain molecular alterations, specific targeted agents may be indicated in place of standard systemic options. The complete regimen — including which agents apply and under what conditions — is detailed in the full protocol.
References
DOI: 10.1530/ETJ-24-0146
- Since the prognosis of patients with widely invasive FTC is significantly poorer compared to patients with minimally invasive FTC, completion total thyroidectomy with radioactive iodine (RAI) therapy for widely invasive FTC to detect the appearance of distant and local metastasis is strongly recommended in clinical practice guidelines.
- 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.
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