**7. Systemic Treatments for Thyroid Cancer**

Two multikinase inhibitors (MKI), lenvatinib and sorafenib, are currently approved by the US Food and Drug Administration (FDA) for the treatment of advanced DTC. Sorafenib was approved based on the favorable results of a placebo-controlled phase 3 clinical trial (DECISION) [156]. The positive results of the lenvatinib phase 3 SELECT trial [157] as well as a phase 2 study led to the approval of that drug [158]. Cabozatinib and vandetanib are approved by the FDA for the treatment of MTC. Vandetanib is approved for symptomatic, unresectable, locally advanced, or metastatic MTC in patients based on a phase 3 trial (ZETA) [159]. Cabozantinib was studied in a phase 3 clinical trial

(EXAM) [160] and showed good results while another clinical trial in MTC patients is still active (EXAMINER, NCT01896479). RET-inhibitors have been studied as well for thyroid cancers that harbor *RET* mutations (NCT03157128, NCT04211337, NCT03906331, NCT04280081, NCT03037385).
