25
Recommendation 71
➤ In patients with progressive RAIR DTC harboring other potentially
actionable non-NTRK/RET/ALK/BRAF
V600E
targets, enrollment in a
clinical trial or first-line lenvatinib is suggested. (C-L)
Recommendation 72
A. Whenever feasible, surgical or core tumor biopsy to allow for NGS
testing to identify potential molecular mechanisms of acquired
resistance should be performed. (GPS)
B. Surgical or core biopsy is preferred over circulating tumor DNA
(ctDNA) analysis, which may be considered for patients in whom
tumor biopsy is not possible. (C-L)
Recommendation 73
➤ Immune checkpoint inhibitors or other forms of immunotherapy may
be offered in selected cases, such as when tumors harbor a high tumor
mutational burden or are mismatch repair deficient. (C-L)
Recommendation 74
A. Redifferentiation by mitogen-activated protein kinase (MAPK)
pathway blockade in patients with progressive RAIR DTC harboring
targetable mutations may be considered in selected patients.
Clinical trial participation is encouraged. (C-L)
B. Redifferentiation approaches in adjuvant RAI treatment for patients
with high-risk, non-gene selected DTC is not recommended. (S-M)
Recommendation 75
➤ Cytotoxic chemotherapy can be considered in RAIR DTC patients with
metastatic, rapidly progressive, symptomatic, and/or imminently
threatening disease not amenable to control through other approaches.
Use within the context of a therapeutic clinical trial is preferred. (C-L)
Recommendation 76
➤ For patients with RAIR DTC with solitary or oligo-metastases (two to five
lesions), focal ablative treatment may be considered. Optimal treatment
approaches may be best addressed in a multidisciplinary setting. (C-L)
Recommendation 77
➤ For patients with symptomatic RAIR DTC, local treatment is suggested.
Surgery, radiotherapy, and percutaneous thermo-ablative approaches
are available to treat individual symptomatic sites of disease. (C-M)
