The management of thyroid carcinomas commonly involves thyroidectomy, radioactive iodine to ablate any thyroid remnant in patients at high risk of recurrence, and suppressive thyroid hormone replacement. However many tumors will de-differentiate and become refractory to radioactive iodine. After progressive dedifferentiation the prognosis for these patients is poor, with no curative options available as these tumors respond poorly to currently available agents. In this review, we examine the unique biology of thyroid cancer and the various intracellular pathways which are currently the subject of intensive focus. Trials evaluating the efficacy of cytotoxic chemotherapeutic agents in iodine-refractory thyroid carcinoma and current novel therapeutic approaches will be emphasized.
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