Papillary Thyroid Cancer with Distant Metastases: What to Do When Lenvatinib or Sorafenib Shows Single-Site Progression

This protocol applies to patients with papillary thyroid carcinoma (PTC) and distant metastases — most commonly to the lung or bone — who developed single-site disease progression while receiving first-line multikinase inhibitor (MKI) therapy.

Clinical Scenario

Papillary thyroid carcinoma with distant metastases (most commonly lung or bone), with single-site progression occurring on ongoing MKI therapy.

When First-Line MKI Therapy Has Not Fully Controlled Disease

First-line systemic therapy with lenvatinib or sorafenib targets reduction in serum thyroglobulin and absence of disease progression on imaging. When a single site progresses despite continued MKI therapy, this next-line protocol is indicated.

Next-Line Approach (Partial Overview)

The approach focuses on locoregional management of the single progressing site — the full protocol details which modalities apply and how the MKI is handled alongside them.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/annonc/mdz400

Patients with distant metastases should receive 100–200 mCi (3.7–7.4 GBq) of 131I after TSH stimulation.

In the presence of single-site progression, locoregional treatment (e.g. EBRT, embolisation, percutaneous treatment modalities) can be done for local control, without discontinuing MKIs.

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