Abstract: Treatment strategies for distant metastatic thyroid cancer in the era of target and immune therapy        CHEN Jia-ying, WANG Yu. Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Corresponding author: WANG Yu, E-mail：Neck130@hotmail.com
Abstract    Thyroid cancer is the most common endocrine tumor. Patients with advanced thyroid cancer cannot be cured by surgery, are refractory to iodine treatment, and are insensitive to radiotherapy and chemotherapy. The prognosis of patients is poor with ineffective therapies, and most of the annual deaths are among these patients. The in-depth understanding of tumor molecular biology and the discovery of driver genes have led to the rapid development of precision treatment of distant metastatic thyroid cancer. Driver genes are the fundamental driving factors for the occurrence and development of thyroid cancer. The discovery of gene mutations such as BRAF, TERT, and RET fusions for guides efficient and precise treatment of patients with advanced DTC, PTDC, MTC, and ATC. At the same time, related targeted and immune drugs are also booming, and the treatment of advanced thyroid cancer has entered the era of targeted therapy. Currently, multiple multi-target tyrosine kinase inhibitors and highly selective inhibitors are approved for the treatment of advanced and metastatic thyroid cancer. Treatment with PD-1/L1 inhibitors is also being explored in specific pathological types of thyroid cancer.  In clinical practice, it is necessary to rationally select medication practices and strategies based on the patient's disease development, pathology, and molecular characteristics to improve advanced patients' survival rate and quality of life.

Key words: thyroid cancer, distant metastasis, target therapy, immunotherapy 

摘要： 甲状腺癌是最常见内分泌系统肿瘤。晚期甲状腺癌病人无法做到手术根治，碘难治以及放化疗不敏感,因而缺少有效的治疗手段。病人的预后较差，每年的死亡病例主要集中在此类病人中。对肿瘤分子生物学的深入理解和驱动基因的发现引领了远处转移甲状腺癌精准治疗的飞速发展。驱动基因是甲状腺癌发生发展的根本驱动因素，BRAF、TERT、RET融合等基因突变的发现为晚期分化型甲状腺（DTC）、低分化甲状腺癌（PTDC）、甲状腺髓样癌（MTC）、未分化甲状腺癌（ATC）病人的高效精准治疗的指导提供了依据。同时，相关的靶向和免疫药物也在蓬勃发展，晚期甲状腺癌的治疗已经进入了靶向治疗的时代。目前，有多个多靶点酪氨酸激酶抑制剂和高选择性抑制剂被批准用于晚期及转移性甲状腺癌的治疗。程序性死亡受体1/配体1（PD-1/PD-L1）抑制剂的治疗也在特定病理学类型的甲状腺癌中探索应用。在临床实践中，需要根据病人的疾病发展、病理和分子特征，合理选择用药实际和用药策略，来提高晚期病人的生存率和生活质量。

关键词: 甲状腺癌, 远处转移, 靶向治疗, 免疫治疗