Papillary thyroid cancer
ICD-10 C73 · ICD-11 2D10.1

Treatment of Progressive Radioiodine-Refractory Papillary Thyroid Cancer with BRAF V600E Mutation

Clinical Scenario

This protocol covers patients with progressive papillary thyroid carcinoma that has become refractory to radioiodine therapy and in whom an oncogenic BRAF V600E mutation has been identified. The coexistence of these two features shapes the first-line systemic treatment strategy.

Specific Situation

Radioiodine-refractory (RAIR) disease with confirmed BRAF V600E mutation represents a clinically distinct population. The mutation status is a key factor in determining which first-line option is most appropriate, particularly when patient comorbidities may affect suitability for the standard first-line agent.

Treatment Approach (Partial Overview)

A targeted systemic agent is generally recommended as first-line therapy for this population. For patients who are poor candidates for that agent, a BRAF V600E-directed approach may be considered as an alternative first-line option. The full eligibility criteria, sequencing logic, and regimen details are in the structured protocol…

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/10507256251363120

Thus, lenvatinib in general is considered as first-line therapy for patients with RAIR progressive BRAFV600E-mutated DTC unless contraindications to its use are present or comorbidities suggest higher risk for lenvatinib-related side effects.

In patients with progressive RAIR DTC harboring an oncogenic BRAFV600E mutation, BRAFV600E-directed therapy may be considered in the first line for patients who are poor candidates for lenvatinib.

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