SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Pharmacology of Anti-Cancer Drugs
A Bayesian Network Meta-Analysis: Evaluating the Efficacy and Safety of Targeted Therapies in Metastatic or Advanced Radioiodine-Refractory Differentiated Thyroid Cancer (RAIR-DTC)
Provisionally accepted
- 1Chengdu Third People's Hospital, Chengdu, China
- 2The Second People's Hospital of Jintang County, chengdu, China
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Background: Approximately 5%–10% of patients with differentiated thyroid cancer (DTC) develop resistance to radioactive iodine (RAI), leading to unsatisfactory survival rates. The optimal medication for advanced or metastatic RAI-resistant differentiated thyroid cancer (RAIR-DTC) remains unclear. Methods: We conducted a Bayesian network meta-analysis based on a systematic search of six electronic databases. The primary outcome was progression-free survival (PFS); secondary outcomes included overall survival (OS), objective response rate (ORR), and grade ≥3 adverse events (AEs). Hazard ratios (HRs) with 95% credible intervals (CrIs) were used for time-to-event outcomes, while odds ratios (ORs) with 95% CrIs were used for binary outcomes. A separate Bayesian network meta-analysis was performed for each endpoint. Results: Our study included 9 RCTs involving 1,760 patients with RAIR-DTC. Lenvatinib, anlotinib, apatinib, and cabozantinib all significantly improved PFS versus placebo (HRs: 3.85–5.36), with lenvatinib ranking first overall (SUCRA: 81.97%) and showing sustained benefit up to 24 months. Apatinib provided early PFS advantage but waning efficacy beyond 6–9 months. No treatment significantly improved OS, though apatinib consistently ranked highest for OS. Lenvatinib achieved the highest objective response rate (OR = 143.18; SUCRA: 82.09%). For grade ≥3 adverse events, no treatment differed significantly from placebo; however, apatinib ranked highest in safety (SUCRA = 93.16%). Conclusion: Lenvatinib demonstrates the greatest benefit in both PFS and ORR among the evaluated TKIs for RAIR-DTC, suggesting it as a potential preferred first-line option. The time-dependent efficacy patterns of other TKIs warrant further investigation.
Keywords: Bayesian network time-trend analysis, Metastatic or advanced radioiodine-refractory differentiated thyroid cancer, Objective response rate, Progression-free survival, target therapy
Received: 09 Oct 2025; Accepted: 13 Feb 2026.
Copyright: © 2026 Wang, Li, Liu, Shi, Zhang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Pin Wang
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