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THYROID CANCER :, Alternatives, Chemotherapy to be used :, IN THE CASE OF…
THYROID CANCER :
Papillary Thyroid Cancer (PTC) or Follicular Thyroid Cancer (FTC)
Active Surveillance
Surgery (lobectomy or total thyroidectomy)
Assess Response
Residual disease
-Another surgery (preferred)
Good Response
Radioactive Iodine Therapy
Medullary Thyroid Cancer (MTC)
Total Thyroidectomy
Monitor Blood Test (Calcitonin and CEA)
Normal levels
Continue Monitoring
Abnormal levels
Radiotherapy
Systemic chemotherapy
Vandetanib or Cabozatinib
TMB-H
Pembrolizumab
RET mutation +ve
Pralsetenib
Surgery
Anaplastic Thyroid Cancer
Alternatives
-Systemic chemotherapy
Larotrectinib
Selpercatinib
Levatinib is the preferred option
Pembrolizumab
Radioactive Iodine therapy
Radiotherapy
Chemotherapy to be used :
Larotrectinib
Selpercatinib
Dabrafenib
IN THE CASE OF RECCURENCE OR METASTASIS :
-Surgery, Radioactive Iodine, or a combination of both
Systemic Chemotherapy
(ATC)
Total thyroidectomy
Assess Response
Uncomplete response
Radiotherapy + Chemotherapy
Good response
Radiotherapy
If contraindications to surgery
Radiotherapy with or without chemotherapy
NTRK +VE
RET mutation +VE
TMB-H
BRAF mutation +ve
RET mutation +ve
NTRK mutation +ve