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CME: Therapeutic options and present gaps in the management of refractory and metastatic differentiated thyroid cancer


Activity Description / Statement of Need:

In this online, self-learning activity:

The incidence of differentiated thyroid cancer (DTC) has risen over the last decade, and there are over 43,000 new cases and 2,200 deaths each year. DTC accounts for 95% of all thyroid cancers and can be categorized as papillary or follicular cancer. Thyroid cancer diagnosed and treated at an early stage has a favorable prognosis, with a 5-year survival rate of 99.9%. However, 5-year survival decreases to 53.3% for those patients with advanced or metastatic disease. Patients with disease that has progressed despite TSH-suppressive therapy or radioiodine may be considered for systemic therapy. Patients without a specific targetable marker may receive a multitargeted kinase inhibitor, while those with one may preferentially receive another agent such as a RET inhibitor, NTRK inhibitor, or BRAF inhibitor. DTC may present with actionable mutations, so patients with radioiodine-refractory (RAI-R) or metastatic disease should undergo genomic testing to assess mutation status, deficient mismatch repair (dMMR), microsatellite instability (MSI), and tumor mutational burden (TMB) to identify therapeutic targets.

Target Audience:

HCPs including: Medical oncologists and endocrinologists; physician assistants, nurse practitioners, nurses, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with RAI-R or metastatic DTC.

Commercial Support Disclosure: This program is supported by an educational grant from Exelixis.

This activity is free of charge.

Release Date: May 11, 2023 -- Expiration Date: May 11, 2024

Faculty: Gregory Daniels, MD, PhD


Faculty introduction, disclosures

Introductory content: defining the context and challenge of RAI-R and metastatic DTC

  • Epidemiology
  • Disease and treatment course prior to consideration of systemic therapy
  • Genomic testing for mutation status, dMMR, MSI, TMB

Treatment of DTC 

  • Goals of therapy
  • Selecting candidates for systemic therapy: tumor size, presence of symptomology
  • Targetable biomarkers not present
    • Multitargeted kinase inhibitor
    • Cases with multitargeted kinase inhibitor contraindication
  • Approaches to targetable biomarkers, including the roles of: TRK inhibition, RET inhibition, BRAF inhibition, andPI3K inhibition
  • Challenges in RAI-R / metastatic DTC
    • Approaches to kinase intolerance
    • Monitoring for, preventing, and managing toxicities
  • Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Recall present and emerging treatment options for RAI-R or metastatic DTC and monitoring parameters for safety and efficacy of treatment.
  • Develop a safe and effective treatment plan for patients with RAI-R or metastatic DTC.
  • Discuss present challenges in the management of RAI-R or metastatic DTC.


ACCME Activity #202515817


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by ScientiaCME.

Disclosure of Faculty: Gregory A. Daniels, MD, PhD, Professor of Medicine, University of California San Diego, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty WILL discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Exelixis.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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