Targeted therapy for thyroid cancers

Targeted therapies might be used if papillary or follicular thyroid cancer has:

• stopped responding to radioactive iodine treatment.
• spread to other parts of the body
• come back.

The 2 main targeted therapy drugs used to treat papillary or follicular thyroid cancer are:

• lenvatinib (Lenvima^®) – capsules taken once a day
• sorafenib ( Nexavar^®) – tablets taken 2 times a day.

Lenvatinib and sorafenib are a type of targeted drugs called tyrosine kinase inhibitors (TKIs). They block (inhibit) signals in the cancer cells that make them grow and divide. They can help to shrink the cancer and to control it, sometimes for a long time.

Other targeted therapy drugs may be used to treat thyroid cancer if there is a certain gene change (mutation) in the cancer cells. For example, they may work if the cancer cells have changes in the RET, NTRK, or BRAF gene.

Your cancer doctor may test cancer cells taken from your biopsy or thyroid surgery to look for these gene changes. This is called molecular testing.

If the cancer cells have a change in the RET gene your doctor might talk to you about having a drug called selpercatinib (Retsevmo^®). This drug belongs to a group of targeted therapy drugs known as cancer growth inhibitors. It can only be used if the thyroid cancer cells have a change in a gene called RET.

This gene change encourages the cancer cells to grow and divide. Selpercatinib blocks the effect of this gene change and slows or stops the cancer cell growth.

You might have selpercatinib either:

• if lenvatinib or sorafenib are not controlling the cancer
• as your first targeted therapy drug if radioactive iodine has not got rid of all the cancer.

You take selpercatinib as capsules, 2 times a day.

Your cancer doctor will discuss with you if any of these drugs are suitable and available for you.

These drugs cannot cure medullary thyroid cancer (MTC), but they can slow its growth and help with symptoms.

Cabozantinib (Cometriq^®) and vandetanib (Caprelsa^®) are types of targeted therapy drugs called tyrosine kinase inhibitors (TKI). They work by blocking signals that encourage the thyroid cancer cells to grow and divide.

Cabozantanib or vandetanib are used to treat medullary thyroid cancer when:

• you cannot have surgery
• the cancer is causing symptoms
• the cancer has spread.

Vandetanib is not widely available throughout the UK. If you and your cancer doctor agree that you would benefit from the treatment, they can apply to the NHS for funding. We have more information about what you can do if a treatment is not available.

There are also other targeted therapies that work if the medullary cancer cells have gene changes (mutations) called RET mutations.

Selpercatinib (Retsevmo^®) belongs to a group of targeted therapy drugs known as cancer growth inhibitors. It can only be used to treat MTC if the cancer cells have a change in a gene called RET.

The gene change encourages the cancer cells to grow and divide. Selpercatinib blocks the effect of this gene change and slows or stops the cancer cell growth.

You take selpercatinib as capsules, 2 times a day.