24
Treatment
Recommendation 64
A. For most patients with progressive RAI-refractory DTC initiating
lenvatinib, 24 mg once daily is the recommended starting dose; a
lower starting dose may be indicated in selected patients. (S-H)
B. Dose holds and dose reductions are important strategies for
managing adverse events related to lenvatinib. (GPS)
Recommendation 65
➤ Prevention, amelioration, and timely management of adverse events is
required for patients treated with MKIs. Patients initiating MKI therapy
should be evaluated at baseline and no less often than every 2 weeks
for the first 2 months of treatment to manage adverse events and then
generally at 1- or 2-month intervals thereafter. (GPS)
Recommendation 66
➤ Cabozantinib should be offered as second-line therapy for patients
with RAIR DTC without an actionable oncogenic driver alteration who
have progressed on or did not tolerate, prior MKI therapy, if they desire
ongoing treatment, and do not have a contraindication to therapy. (S-H)
Recommendation 67
➤ In patients with progressive RAIR DTC harboring an oncogenic
neurotrophic receptor tyrosine kinase (NTRK) fusion, NTRK-targeted
therapy is recommended in the first line. (S-M)
Recommendation 68
➤ In patients with progressive RAIR DTC harboring an oncogenic RET
fusion, RET-targeted therapy is recommended in the first line. (S-M)
Recommendation 69
➤ In patients with progressive RAIR DTC harboring an oncogenic ALK
fusion, ALK-targeted therapy is recommended in the first line. (S-L)
Recommendation 70
A. In patients with progressive RAIR DTC harboring an oncogenic
BRAF
V600E
mutation, BRAF
V600E
-directed therapy may be considered in
the first line for patients who are poor candidates for lenvatinib. (C-M)
B. BRAF-directed treatment is recommended in patients with BRAF
V600E
mutation-positive RAIR DTC who have progressed on or did not
tolerate one or more prior MKI therapies. (S-M)
C. Currently approved BRAF-directed therapies are not recommended
in DTCs harboring non-V600 BRAF alterations. (S-M)
