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Papillary thyroid cancer: lines of therapy

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4 standard-of-care settings across 3 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersFRαRisk group
Early / localised··2
Third line and beyond·1·
Other settings1··

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
Risk groupLow riskLobectomy or total thyroidectomy without radioactive iodine (ESTIMABL2, IoN); levothyroxine and thyroglobulin follow-up.-
Risk groupIntermediate and high riskTotal thyroidectomy with neck dissection where nodes are involved, radioactive iodine ablation, TSH suppression.84

Third line and beyond

SubgroupSettingApproachProducts and trialsEvidence
FRαIodine-refractory advanced diseaseLenvatinib (SELECT) or sorafenib (DECISION); selpercatinib for RET fusions, larotrectinib or entrectinib for NTRK fusions, dabrafenib plus trametinib for BRAF V600E.91

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersPapillary microcarcinomaActive surveillance with ultrasound or lobectomy; surveillance is safe in most adults after the Kuma Hospital and Memorial Sloan Kettering series.63

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.