Thyroid Cancers: From Surgery to Current and Future Systemic Therapies through Their Molecular Identities

• Published in: International journal of molecular sciences Vol. 22; no. 6; p. 3117
• Main Authors: Lorusso, Loredana, Cappagli, Virginia, Valerio, Laura, Giani, Carlotta, Viola, David, Puleo, Luciana, Gambale, Carla, Minaldi, Elisa, Campopiano, Maria Cristina, Matrone, Antonio, Bottici, Valeria, Agate, Laura, Molinaro, Eleonora, Elisei, Rossella
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 18.03.2021; MDPI AG
• Subjects: Animals; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; differentiated thyroid cancer; Humans; lenvatinib; medullary thyroid cancer; Molecular Targeted Therapy; Review; Signal Transduction; sorafenib; targeted therapy; Thyroid Neoplasms - drug therapy; Thyroid Neoplasms - genetics; Thyroid Neoplasms - surgery; Tumor Microenvironment - immunology; tyrosine kinase inhibitors; tyrosine kinase inhibitors; targeted therapy; lenvatinib; sorafenib; vandetanib; selpercatinib; medullary thyroid cancer; pralsetinib; differentiated thyroid cancer; cabozantinib
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms22063117

Differentiated thyroid cancers (DTC) are commonly and successfully treated with total thyroidectomy plus/minus radioiodine therapy (RAI). Medullary thyroid cancer (MTC) is only treated with surgery but only intrathyroidal tumors are cured. The worst prognosis is for anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC). Whenever a local or metastatic advanced disease is present, other treatments are required, varying from local to systemic therapies. In the last decade, the efficacy of the targeted therapies and, in particular, tyrosine kinase inhibitors (TKIs) has been demonstrated. They can prolong the disease progression-free survival and represent the most important therapeutic option for the treatment of advanced and progressive thyroid cancer. Currently, lenvatinib and sorafenib are the approved drugs for the treatment of RAI-refractory DTC and PDTC while advanced MTC can be treated with either cabozantinib or vandetanib. Dabrafenib plus trametinib is the only approved treatment by FDA for mutated ATC. A new generation of TKIs, specifically for single altered oncogenes, is under evaluation in phase 2 and 3 clinical trials. The aim of this review was to provide an overview of the current and future treatments of thyroid cancer with regards to the advanced and progressive cases that require systemic therapies that are becoming more and more targeted on the molecular identity of the tumor.