Follicular thyroid cancer medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Pharmacologic medical therapies for follicular thyroid cancer include radioactive iodine therapy and targeted medical therapy.

• Thyroxine is recommended as a replacement therapy for all patients with follicular thyroid cancer especially for micronodular pulmonary metastases.^[1]

• Radioactive iodine ablation therapy may be used to prevent the recurrence of cancer.
• High doses of radioiodine is also used to treat microscopic bone metastasis.

• This type of treatment is done using:^[2][3]
  • Sorafenib, is an orally active, multityrosine kinase inhibitor.
  • Lenvatinib, an orally active, multitargeted tyrosine kinase inhibitor.^[4]

Adult

• Preferred regimen: Lenvatinib 24 mg PO daily until disease progression or unacceptable toxicity.
• Alternative regimen: Sorefenib 400 mg PO q12h until disease progression or unacceptable toxicity.
• Alternative regimen: Larotrectinib 100 mg PO q12h until disease progression or unacceptable toxicity.
• Alternative regimen: Entrectinib 600 mg PO daily until disease progression or unacceptable toxicity.

• External radiation therapy is used for bone pain in bone metastasis.

• Intravenous infusions of bisphosphonate is also used to reduce pain in bone metastasis.
• Corticosteroid therapy is recommended for cerebral edema secondary to brain metastasis.