A subset of patients with papillary thyroid carcinoma develop disease that progresses despite radioiodine and is found to carry an oncogenic ALK gene fusion. This molecularly defined subgroup has a specific recommended first-line treatment approach.
This protocol addresses progressive radioiodine-refractory (RAIR) papillary thyroid carcinoma in which molecular testing identifies an oncogenic ALK gene fusion. In this setting, ALK-targeted therapy is recommended in the first line.
The recommended approach involves ALK-targeted therapy. Multiple ALK-specific agents have demonstrated activity in this setting — the full regimen selection and sequencing are detailed in the structured protocol.
DOI: 10.1177/10507256251363120
In patients with progressive RAIR DTC harboring an oncogenic ALK fusion, anaplastic lymphoma kinase (ALK)-targeted therapy is recommended in the first line.
Case reports have detailed impressive efficacy of ALK-specific therapies, such as crizotinib, alectinib, and lorlatinib, in several patients with ALK fusion-positive RAIR DTC.
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