Sorafenib vs chemotherapy in the treatment of locally advanced or metastatic, radioactive iodine-refractory differentiated thyroid cancer: real-world data from Turkey.

Managing locally advanced, or metastatic radioactive iodine-refractory differentiated thyroid cancers (RAIR-DTC) poses substantial challenges, with few available treatment options. The aim of this study was to evaluate clinical outcomes of patients receiving sorafenib as first line treatment. In addition, prognostic markers affecting progression-free survival (PFS) were identified. This retrospective, 6 centers study included 62 patients with locally advanced or RAIR-DTC treated 2008-2023. The median PFS was 16.5 months. The presence of liver metastases was strongly associated with a lower PFS (3.1 months (p < 0.001)). The use of sorafenib as initial treatment resulted longer PFS compared to chemotherapy, with a median of 25.5 vs 4.7 months respectively (p = 0.01). Increased neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with worse outcomes (p = 0.01; p = 0.009, respectively). In conclusion, sorafenib has demonstrated significant PFS benefits when used as first-line treatment. It has been shown that the presence of liver metastases and higher levels of NLR and PLR are associated with a more unfavorable prognosis.