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Clinical trials are important for patients with progressive radioactive iodine (RAI)-refractory differentiated thyroid cancer and should be offered prior to the initiation of systemic therapy, believes Manisha H. Shah, MD. Studies have shown promising results for targeted TKIs, specifically cabozantinib, lenvatinib, and BRAF/MEK inhibitors.
Prior to the administration of systemic therapy, patients should be educated on side effect management and quality of life, notes Francis P. Worden, MD. With sorafenib, physicians should monitor for hand-foot syndrome, fatigue, and hypertension in a multidisciplinary environment.
Many of the side effects associated with sorafenib peak at 4 months, decline, and then plateau, explains Marcia S. Brose, MD, PhD. Providing this information along with response data encourages patients to push through these early adverse events, Brose notes.
As an indolent disease, many thyroid cancer patients are not accustomed to frequent visits, notes Shah. As a result, patients should be educated upfront on the management of potential adverse events. Follow-up is generally conducted by telephone, placing an emphasis on the role of the nurse as part of a treatment team, states Shah.