Would you consider low dose lenvatinib or dabrafenib/trametinib for rapidly progressive RAI refractory thyroid cancer with BRAF V600E mutation in a patient in whom you are concerned about tolerance of full dose lenvatinib?

I would start with lower doses of Dabrafenib (50 mg BID) and Trametinib (0.5 mg QD) and increase doses as tolerated. I institute Lenvatinib if they fail Dabrafenib and Trametinib. It is not unusual for me to start Lenvatinib at 10 mg daily. But I do not give more 20 mg daily dose.