Would you prescribe TKIs for Stage IV differentiated thyroid cancer patients who are RAI-naive, with preserved performance status, and are not eligible for surgery?   

TKI therapies, including those targeting RET, NTRK, and BRAF are indicated for patients with RAI-refractory disease. I am assuming the patient in question has locally advanced disease that requires surgery, but is too advanced for resection. Presently, we do not have data to support the use of TKI t...

If the tumor harbors BRAF V600E or RET or NTREK fusion, I would switch to TKI and it would be on label (tumor-agnostic approvals). There are TKIs approved in the current space, Lenvatinib, sorafenib, and second-line cabozantinib. If progression is low, watchful waiting is totally reasonable.