Use of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer - a multidisciplinary perspective for daily practice

Sep 24, 2026

Background: Most thyroid cancers of follicular origin have favorable outcomes, but a subset progresses to metastatic disease that can become radioiodine refractory (RAI-R). Key challenges include timely diagnosis, choosing local and systemic treatments, managing therapy side effects, and coordinating care among specialists, patients, and caregivers. Methods: A multidisciplinary expert group developed practical suggestions based on shared clinical experience in RAI-R differentiated thyroid cancer treated with lenvatinib, covering patient selection, therapy initiation, follow-up, and adverse-event management. Conclusions: Guidance supports systemic management of RAI-R DTC with lenvatinib, emphasizing adherence and compliance, baseline work-up, symptom relevance, multidisciplinary assessment, patient education, and practical information on dosing, monitoring, and managing discontinuation and reinitiation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Abstract

Background

Methods

Conclusions

Introduction

J Capdevila et al. 12:5 e230068 RESEARCH Use of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer: a multidisciplinary perspective for daily practice Jaume Capdevila1, Desiree’ Deandreis2, Cosimo Durante3, Sophie Leboulleux4, Markus Luster5, Romana Netea-Maier6, Kate Newbold7, Susanne Singer8, Gerasimos P Sykiotis9, Beate Bartes10, Kate Farnell11 and Laura Deborah Locati12,13 1Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), IOB Quiron-Teknon, Barcelona, Spain 2Department of Medical Sciences, Nuclear Medicine Unit, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy 3Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy 4Service of Endocrinology, Diabetology, University Hospital Geneve, Geneve, Switzerland 5Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany 6Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands 7Royal Marsden Hospital, London, United Kingdom 8Institute of Medical Biostatistics Epidemiology and Informatics (IMBEI), University Medical Center of Johannes Gutenberg University, Mainz, Germany 9Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland 10Association “Vivre sans Thyroïde”, Léguevin, France 11Butterfly Thyroid Cancer Trust, Rowlands Gill, Tyne & Wear, UK 12Medical Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy 13Department of Internal Medicine and Therapeutics, University of Pavia, Italy Correspondence should be addressed to L D Locati: [lauradeborah.locati@unipv.it](lauradeborah.locati@unipv.it) Abstract Background: Most thyroid cancers of follicular origin have a favorable outcome. Only a small percentage of patients will develop metastatic disease, some of which will become radioiodine refractory (RAI-R) . Important challenges to ensure the best therapeutic outcomes include proper, timely, and appropriate diagnosis; decisions on local, systemic treatments; management of side effects of therapies; and a good relationship between the specialist, patients, and caregivers. Methods: With the aim of providing suggestions that can be useful in everyday practice, a multidisciplinary group of experts organized the following document, based on their shared clinical experience with patients with RAI-R differentiated thyroid cancer (DTC) undergoing treatment with lenvatinib. The main areas covered are patient selection, initiation of therapy, follow-up, and management of adverse events. Conclusions: It is essential to provide guidance for the management of RAI-R DTC patients with systemic therapies, and especially lenvatinib, since compliance and adherence to treatment are fundamental to achieve the best outcomes. While the therapeutic landscape in RAI-R DTC is evolving, with new targeted therapies, immunotherapy, etc., lenvatinib is expected to remain a first-line treatment and mainstay of therapy for several years in the vast majority of patients and settings. The guidance herein covers baseline work-up and initiation of systemic therapy, relevance of symptoms, multidisciplinary assessment, and patient education. Practical information based on expert experience Key Words f differentiated thyroid cancer f lenvatinib f radioiodine refractory f toxicity f management J Capdevila et al. 12:5 e230068 is also given for the starting dose of lenvatinib, follow-up and monitoring, as well as the management of adverse events and discontinuation and reinitiating of therapy. The importance of patient engagement is also stressed. Introduction The incidence of thyroid cancer (TC) has steadily increased by 20% from 1990 to 2013 and is now predicted to be the fourth leading type of cancer globally (1). The increase has been ascribed primarily to the ability to detec

FAQs

What clinical challenges does the guidance address for RAI-R differentiated thyroid cancer patients?

It targets proper and timely diagnosis, decisions on local versus systemic therapy, management of treatment side effects, and coordination between specialists, patients, and caregivers.

What areas does the multidisciplinary expert group cover regarding lenvatinib treatment?

The guidance covers patient selection, initiation of therapy, follow-up, and management of adverse events, including practical information on dosing and monitoring.

Why is patient adherence emphasized in this guidance for lenvatinib therapy?

The document states that compliance and adherence are fundamental to achieve the best therapeutic outcomes in RAI-R DTC patients.

Sep 24, 2026

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