Presentation (CTI)

OBJECTIVES: While differentiated thyroid cancer (DTC) is often responsive to standard therapies, a subset of patients develops radioiodine-refractory disease (RR-DTC), where treatment options remain limited and outcomes poor. This study aims to evaluate and rank the clinical efficacy of targeted therapeutics in RR-DTC using a Bayesian network meta-analysis (NMA).
METHODS: A systematic literature review was conducted using MEDLINE®, Embase®, and EBM Reviews and grey literature sources. Out of 5334 screened records, 11 studies were included in the analysis. Bayesian NMA was performed in R to assess Overall survival (OS), Progression free survival (PFS) and Objective Response Rate (ORR). Treatment effects were reported as Hazard ratio (HR) with 95% Credible interval (Crls), and SUCRA values were used for ranking. Pooled proportions were calculated for ORR due to zero events in the placebo arms. Subgroup analysis was performed for advanced/metastatic RR-DTC populations. Model convergence was verified using trace plots.
RESULTS: Ten studies (n=2,031) were included for OS and seven (n=1490) for PFS. Apatinib demonstrated more favourable OS benefit (SUCRA: 0.91; HR: 0.42 [95% Crl: 0.28-0.63]) followed by Lenvatinib (SUCRA: 0.74; HR: 0.56[95% Crl:0.44-0.70]). For PFS, Lenvatinib ranked highest (SUCRA: 0.83; HR: 0.20[95% Crl:0.071-0.54]). The pooled ORR for Lenvatinib was 66% of [95% CI: 61% to 71%]. In subgroup analysis for locally advanced/metastatic RR-DTC, Apatinib ranked highest for OS (SUCRA: 0.82; HR: 0.42[95% Crl:0.13-1.3]) and Anlotinib for PFS (SUCRA: 0.82; HR: 0.21[95% Crl:0.030-1.5]). No publication bias was detected.
CONCLUSIONS: This analysis shows Apatinib provides superior overall survival while Lenvatinib offers better progression-free survival and response rates in radioiodine-refractory DTC. However, findings should be interpreted cautiously due to limited studies and wide confidence intervals in subgroup analyses.