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Frontline Treatment Selection in RAI-Refractory DTC

Insights From: Robert I. Haddad, MD, Dana-Farber; Matthew H. Taylor, MD, Oregon Health;R. Michael Tuttle, MD, MSKCC
Published: Friday, May 22, 2015
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It is not yet apparent which of the two FDA-approved agents available to treat RAI-intolerant differentiated thyroid cancer (DTC) should be utilized in the frontline setting. Both sorafenib and lenvatinib have shown positive response rates and progression-free survival benefits, but each has unique side effect profiles.

The frontline treatment process, according to Matthew H. Taylor, MD, should be stratified based on a patient’s comorbid illnesses. For example, if a patient at baseline has severe hypertension that has been refractory to medical management, sorafenib would be the better option compared with lenvatinib. However, if the patient has baseline cutaneous issues that put them at risk for hand-foot syndrome or other cutaneous reactions, lenvatinib would be the preferred choice.

For a patient with no substantial medical comorbidities, Taylor suggests that lenvatinib would be his first choice, based on its impressive response rate and progression-free survival (PFS).

In the phase III SELECT trial, the median PFS was 18.3 months with lenvatinib versus 3.6 months with placebo. The objective response rate (ORR) with lenvatinib was 64.8% versus 1.5% with placebo. In the pivotal DECISION trial, the median PFS was 10.8 months compared with 5.8 months, for sorafenib and placebo, respectively. Partial responses were observed in 12.2% of patients receiving sorafenib compared with 0.5% in the placebo arm. 
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For High-Definition, Click
It is not yet apparent which of the two FDA-approved agents available to treat RAI-intolerant differentiated thyroid cancer (DTC) should be utilized in the frontline setting. Both sorafenib and lenvatinib have shown positive response rates and progression-free survival benefits, but each has unique side effect profiles.

The frontline treatment process, according to Matthew H. Taylor, MD, should be stratified based on a patient’s comorbid illnesses. For example, if a patient at baseline has severe hypertension that has been refractory to medical management, sorafenib would be the better option compared with lenvatinib. However, if the patient has baseline cutaneous issues that put them at risk for hand-foot syndrome or other cutaneous reactions, lenvatinib would be the preferred choice.

For a patient with no substantial medical comorbidities, Taylor suggests that lenvatinib would be his first choice, based on its impressive response rate and progression-free survival (PFS).

In the phase III SELECT trial, the median PFS was 18.3 months with lenvatinib versus 3.6 months with placebo. The objective response rate (ORR) with lenvatinib was 64.8% versus 1.5% with placebo. In the pivotal DECISION trial, the median PFS was 10.8 months compared with 5.8 months, for sorafenib and placebo, respectively. Partial responses were observed in 12.2% of patients receiving sorafenib compared with 0.5% in the placebo arm. 
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