J Korean Med Assoc.  2024 Jul;67(7):484-491. 10.5124/jkma.2024.67.7.484.

Systemic therapy for differentiated thyroid cancer with distant metastasis

• Lee EK

• KMID: 2558009
• DOI: http://doi.org/10.5124/jkma.2024.67.7.484

Abstract

Background
Thyroid cancer is a slow-growing tumor with excellent oncological outcomes. However, few patients with unexpectedly severe outcomes are usually ignored.
Current Concepts
Radioactive iodine therapy is the mainstay treatment for differentiated thyroid cancer with distant metastasis. The refractoriness to radioactive iodine therapy has been overcome by the emergence of targeted agents. First, multikinase inhibitors (sorafenib and lenvatinib) targeting the growth factor pathway were developed and approved as anticancer agents for patients with advanced differentiated thyroid cancer, regardless of their genetic features. With progress in sequencing techniques, the genetic backgrounds of tumors have unveiled new targets, including rearrangements during transformation and tropomyosin receptor kinase. Special attention should be paid to the national health insurance coverage of systemic therapeutics and genetic studies.
Discussion and Conclusion
New drugs were introduced to treat previously untreatable advanced thyroid cancers. However, the cost of these drugs has increased with new developments, and only first-line drugs for thyroid cancer are still covered by insurance. These medical advances will remain an illusion for clinics and patients if improvements in healthcare policies do not accompany them.

Keyword

Thyroid neoplasm; Drug therapy; Molecular targeted therapy; 갑상선암; 약물치료; 표적치료제