Essential news for clinical practice—thyroid cancer

Summary Established systemic treatment options for advanced thyroid cancer include the multityrosine kinase inhibitors lenvatinib and sorafenib for radioactive iodine refractory differentiated thyroid cancer (DTC) and vandetanib and cabozantinib for medullary thyroid cancer (MTC). Recently, the COSMIC-311 study resulted in approval of cabozantinib for DTC with progression upon lenvatinib and/or sorafenib; thus, for the first time a specific second-line therapy has been defined for these patients. In addition, the therapeutic landscape of thyroid cancer has been expanded by targeted therapies based on molecular tumor profiles. Selective RET inhibitors such as selpercatinib and pralsetinib show high activity in DTC with RET fusions and MTC with RET mutations, respectively. Further targeted treatment options include NTRK inhibitors for thyroid cancers with NTRK fusions and BRAF-targeted therapy for BRAF V600E-mutated (anaplastic) thyroid cancer.