ENDOCAN TUTHYREF network consensus recommendations: Refractory follicular-derived thyroid cancer.

Paul Schwartz, Myriam Decaussin-Petrucci, Francoise Borson-Chazot, Arnaud Jannin, Ségolène Hescot, Julien Hadoux, Johanna Wassermann, Camille Buffet, Sophie Leboulleux, Christine Do Cao, Camila Nascimento, Stéphane Bardet, Yann Godbert, Livia Lamartina, Alexandre Lugat, Bérangère Narciso

Journal: Annales d'endocrinologie 2025;86(4):101735

PMID: 40345488

Free Full Text on Elsevier Science View on PubMed

Abstract

Radioactive-iodine-refractory differentiated thyroid cancer (RAIR DTC) represents 3-5% of follicular-derived DTCs, with approximately 200-300 new cases diagnosed annually in France. Median overall survival in the French RAIR DTC database is 9.5years, underscoring the importance of long-term support for caregivers and patients. To guide treatment decision-making, the French ENDOCAN TUTHYREF network has provided algorithms for RAIR DTC management, available at the TUTHYREF website. The present article summarizes these recent practical recommendations, focusing on 5 points. (1) RAIR DTC has long been defined by locally advanced disease not amenable to surgery or metastatic disease not fully responding to radioactive iodine (RAI) therapy, a definition that can be further refined considering prognostic factors. (2) Treatment should be tailored according to tumor burden and progression, with local treatments prioritized for non-progressive or slowly progressive disease. (3) Early tumor molecular testing should be performed to identify driver oncogenes such as BRAF mutation or RET/NTRK/ALK fusion, to optimize access to existing selective targeted therapies. (4) For symptomatic or progressive RAIR DTC, tyrosine multikinase inhibitors, such as sorafenib, lenvatinib or cabozantinib, are the standard therapies, but alternative and 2nd-line kinase inhibitors are also available. (5) Since most therapies are associated with common side-effects such as fatigue and cardiovascular, digestive and skin issues, preparing and monitoring patients for systemic therapy should include careful assessment of comorbidities, toxicity prevention and individual dose adjustment. Overall, management of RAIR DTC requires a multidisciplinary approach, with an emphasis on personalized treatment strategies and proactive therapeutic education.

Address: Department of Endocrinology, CHRU de Lille-Hôpital Claude Huriez, Lille, France. Electronic address: [email protected].; Department of Thyroid Oncology and Nuclear Medicine, Institut Bergonié, Bordeaux, France.; Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France.; Department of Endocrinology, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.; Pathology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.; Medical Oncology Department, Pitié-Salpêtrière Hospital, Paris, France.; Department of Medical Oncology, CHU de Nantes-Hôpital Laennec Saint-Herblain, Nantes, France.; Department of Nuclear Medicine, IUCT Oncopole Claudius Regaud, Toulouse, France.; Department of Endocrinology and Diabetology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.; Department of Medical Oncology, Tours University Hospital, Tours, France.; Department of Endocrinology, CHRU de Lille-Hôpital Claude Huriez, Lille, France.; Department of Medical Imaging, Endocrine Oncology Unit, Gustave Roussy, 94805 Villejuif, France.; Department of Nuclear Medicine, Institut Curie, Saint-Cloud, France.; Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Thyroid Tumors Clinical Research Group, Sorbonne University, Cancer Institute, Paris, France.

DOI: 10.1016/j.ando.2025.101735