Lenvatinib and Pembrolizumab Combination Therapy in RAI Refractory Thyroid Cancer

Lori Wirth, MD, reviews clinical evidence supporting the combination of lenvatinib and pembrolizumab in radioactive iodine–refractory differentiated thyroid cancer. The National Comprehensive Cancer Network includes this regimen as a potential option for select patients, based on a phase 2 multicenter study conducted by the International Thyroid Oncology Group. In treatment-naïve patients, the combination did not demonstrate a clear improvement in complete response rates compared with lenvatinib alone. However, a second cohort evaluating pembrolizumab added at progression on lenvatinib showed that some patients achieved new and durable responses. These findings suggest a potential role for immunotherapy in the salvage setting. Despite this activity, the combination is not currently approved by the FDA for this indication, and its use remains individualized based on patient-specific clinical factors.

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