Lin Y, Qin S, Li Z, et al. - Apatinib, a highly selective vascular endothelial growth factor (VEGFR-2) inhibitor, might serve as a new therapeutic choice for radioactive iodine–refractory differentiated thyroid cancer (RAIR-DTC).

• This is a phase 3 randomized clinical trial of 92 eligible participants (REALITY trial) for testing apatinib in patients with progressive locally advanced or metastatic RAIR-DTC.

• Patients were randomized (1:1) to apatinib, 500 mg/d, or placebo.

• A significant improvement in progression-free survival (PFS) and overall survival was achieved with apatinib vs placebo.

• In the apatinib group, median PFS, confirmed objective response rate and disease control rate were 22.2 months, 54.3%, and 95.7%, respectively; vs 4.5 months, 2.2%, and 58.7% in the placebo group.

• Hypertension was documented as the most common grade 3 or higher-level adverse event.