Superior efficacy of vemurafenib combined with iodine-131 for lymph node metastatic BRAF-mutant thyroid cancer: a long-term survival analysis.

[AIMS] To evaluate the long-term survival outcomes and therapeutic efficacy of vemurafenib combined with iodine-131 (I) by dual pathways in patients with lymph node metastatic BRAF-mutant thyroid cancer.

[METHODS] This retrospective study included 80 patients with lymph node metastatic BRAF V600E-mutant thyroid cancer, treated between January 2022 and January 2025. Patients were assigned to a control group (vemurafenib monotherapy, n = 42) or an observation group (vemurafenib combined with I, n = 38). Progression-free survival (PFS), overall survival (OS), and metastasis-free survival (MFS) were compared. Survival analyses were performed using Kaplan-Meier curves.

[RESULTS] Kaplan-Meier survival analysis showed a significantly lower PFS, OS, and MFS in the control group, compared to the observation group (all P<0.001). Treatment with combination therapy led to significantly superior thyroid function recovery, with lower thyroid-stimulating hormone levels as well as higher free T4, free T3, and total T3 levels in the observation group (all P<0.001). Immune analysis showed significantly enhanced activation of CD8+ T cells and a reduction in regulatory T cells (both P<0.001).

[CONCLUSION] The vemurafenib combined with I revealed superior efficacy in improving survival and thyroid function recovery in lymph node metastatic BRAF-mutant thyroid cancer.