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Thyroid Cancer

Updated : April 26, 2022





Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

axitinib

5

mg

Orally 

twice a day

every 12hrs, on an empty stomach, increase to 7 mg after 6 weeks of toleration.
Reduce the dose to 3-2 mg if adverse effects appear.



cabozantinib

140

mg

orally

once a day

If BSA > or equal to 1.2 m2, 60 mg given orally per day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs



dabrafenib

150

mg

Capsule

Oral

twice a day

The dose can be taken either as single agent or in combination with trametinib Continue the therapy until disease progression or unacceptable effects occur 



vandetanib

Advanced/metastatic Thyroid cancer:

300

mg

Orally 

once a day

(continue the dose based on symptoms, stop if shows any unacceptable toxicity)



Dose Adjustments

Reduce the dose from 300 mg to 200 mg or further 100 if Cardiac: QTcF > 500 msec, Severe diarrhea, Recurrent toxicity grade-1 occurs

trametinib

2

mg

oral

once a day

as a single agent or in combination with dabrafenib



lenvatinib 

Indicated for patients with differentiated thyroid cancer. It may be progressive, locally recurrent, or metastatic, radioactive iodine-refractory differentiated thyroid cancer.
24 mg orally each day (two 10 mg capsules plus one 4 mg capsule)



sorafenib 

sorafenib is indicated to treat metastatic or locally recurrent, differentiated, progressive thyroid cancer that shows refraction to radioactive iodine treatment
A dose of 400 mg orally is administered every 12 hours In case of toxicity of the skin, reduce or discontinue the dose



Dose Adjustments

For differentiated thyroid cancer:
Dose reduction for dermatologic toxicities
1st dose reduction- reduce the dose to 600 mg/day
2nd dose reduction- 200 mg every 12 hours
3rd dose reduction- 200 mg per day
In the case of mild to moderate renal impairment, no dose adjustment is required
Dosing for severe renal impairment is not studied
In the case of mild to moderate hepatic impairment, no dose adjustment is required
Dosing for severe hepatic impairment is not studied

sodium iodide I-131 

In the ablation of normal thyroid tissue, Initially, 30-100 mCi orally (or 1100-3700 MBq)
In subsequent metastases ablation, 100-200 mCi orally (or 3700-7400 MBq)



 

cabozantinib

If BSA > or equal to 1.2 m2, 60 mg given orally per day
If BSA < or equal to 1.2 m2, 40 mg given orally per day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs



pralsetinib 

400

mg

Orally 

every day


Continue until the illness progresses or intolerable toxicity occurs.



pralsetinib 

Age: > 12 years:

400

mg

Orally

every day


Continue until the illness progresses or intolerable toxicity occurs



 

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References

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Thyroid Cancer

Updated : April 26, 2022




axitinib

5

mg

Orally 

twice a day

every 12hrs, on an empty stomach, increase to 7 mg after 6 weeks of toleration.
Reduce the dose to 3-2 mg if adverse effects appear.



cabozantinib

140

mg

orally

once a day

If BSA > or equal to 1.2 m2, 60 mg given orally per day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs



dabrafenib

150

mg

Capsule

Oral

twice a day

The dose can be taken either as single agent or in combination with trametinib Continue the therapy until disease progression or unacceptable effects occur 



vandetanib

Advanced/metastatic Thyroid cancer:

300

mg

Orally 

once a day

(continue the dose based on symptoms, stop if shows any unacceptable toxicity)



Dose Adjustments

Reduce the dose from 300 mg to 200 mg or further 100 if Cardiac: QTcF > 500 msec, Severe diarrhea, Recurrent toxicity grade-1 occurs

trametinib

2

mg

oral

once a day

as a single agent or in combination with dabrafenib



lenvatinib 

Indicated for patients with differentiated thyroid cancer. It may be progressive, locally recurrent, or metastatic, radioactive iodine-refractory differentiated thyroid cancer.
24 mg orally each day (two 10 mg capsules plus one 4 mg capsule)



sorafenib 

sorafenib is indicated to treat metastatic or locally recurrent, differentiated, progressive thyroid cancer that shows refraction to radioactive iodine treatment
A dose of 400 mg orally is administered every 12 hours In case of toxicity of the skin, reduce or discontinue the dose



Dose Adjustments

For differentiated thyroid cancer:
Dose reduction for dermatologic toxicities
1st dose reduction- reduce the dose to 600 mg/day
2nd dose reduction- 200 mg every 12 hours
3rd dose reduction- 200 mg per day
In the case of mild to moderate renal impairment, no dose adjustment is required
Dosing for severe renal impairment is not studied
In the case of mild to moderate hepatic impairment, no dose adjustment is required
Dosing for severe hepatic impairment is not studied

sodium iodide I-131 

In the ablation of normal thyroid tissue, Initially, 30-100 mCi orally (or 1100-3700 MBq)
In subsequent metastases ablation, 100-200 mCi orally (or 3700-7400 MBq)



cabozantinib

If BSA > or equal to 1.2 m2, 60 mg given orally per day
If BSA < or equal to 1.2 m2, 40 mg given orally per day
The treatment needs to be continued until disease progression or unacceptable toxicity occurs



pralsetinib 

400

mg

Orally 

every day


Continue until the illness progresses or intolerable toxicity occurs.



pralsetinib 

Age: > 12 years:

400

mg

Orally

every day


Continue until the illness progresses or intolerable toxicity occurs



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