Challenges in treating radioiodine-refractory thyroid cancer: a global perspective with a focus on developing nations in Latin America

• Published in: Endocrine
• Main Authors: Penna, G C, Rajão, K M A B, Santana, D C, Costa, P H, Carvalho, P H, Gomes, G A, Avelar, G A, Chaves, A L F, Pitoia, F
• Format: Journal Article
• Language: English
• Published: United States 30.07.2024
• Subjects: differentiated thyroid carcinoma; thyroid cancer; lenvatinib; sorafenib; radioiodine-refractory; cabozantinib
• ISSN: 1559-0100; 1559-0100
• DOI: 10.1007/s12020-024-03961-7

This article aims to comprehensively analyze the unique challenges in managing patients with metastatic Differentiated Thyroid Cancer (DTC) that develop radioiodine-refractory disease, especially in developing countries in Latin America. We discuss key contentious aspects of their treatment, such as the optimal timing for initiating systemic therapy, the choice of first-line medications, the appropriate timing for requesting molecular interrogation, and the challenges associated with accessing these drugs and molecular panels. To illustrate these challenges and enhance understanding, we present five real clinical cases from the authors' experiences. Patients with Differentiated Thyroid Cancer (DTC) generally have an excellent prognosis, with an overall 10-year survival rate exceeding 97%. However, approximately 5% of DTC patients, especially those with distant metastases, may develop radioiodine-refractory disease, reducing survival rates. Access to medications remains difficult and time-consuming, particularly for patients within the public healthcare system. Urgent discussions on drug pricing involving all stakeholders are imperative. To break free from complacency, stakeholders must prioritize patient well-being by advocating for evidence-based drug pricing, increased participation in clinical trials, and streamlined regulatory processes. Beyond the recognized need for prospective randomized clinical trials to determine the optimal first-line drug and the timing of molecular testing, this type of manuscript plays a pivotal role in stimulating discussions and disseminating comprehensive knowledge about the challenges associated with treating and monitoring patients with radioiodine-refractory thyroid carcinoma, especially in developing countries.