Anlotinib or Penpulimab in Combination With RAI for DTC

Inclusion Criteria:

• local advanced or metastatic differentiated thyroid cancer (DTC)
• scheduled to receive RAI treatment.
• absence of good remission of RAI or may not get satisfactory remission from RAItreatment
• At least one measurable lesion, with diameter ≥ 10mm measured by spiral MRI/CT scanper RECIST1.1.
• Be 18 years of age or older, ECOG PS: 0-2. Life expectancy of at least 6 months.
• Main organs function is normal.
• The woman patients of childbearing age who must agree to take contraceptive methods (e.g. intrauterine device, contraceptive pill or condom) during the research andwithin another 6 months after it; who are not in the lactation period and examined asnegative in blood serum test or urine pregnancy test within 7 days before theresearch; The man patients who must agree to take contraceptive methods during theresearch and within another 6 months after it.

Exclusion Criteria:

• Patients who had previously received treatment with Antiangiogenic tyrosine kinaseinhibitors, such as: Anlotinib, apatinib and Lenvatinib.
• Patients who had previously received local treatment within 4 weeks or Participated inother anti-tumor clinical trials within 4 weeks.
• Patients with previous or current concurrent malignancies or solid organs or bonemarrow transplants within 5 years. Exceptions include basal cell carcinoma of theskin, squamous cell carcinoma of the skin, or in situ cervical cancer that hasundergone potentially curative therapy
• Unmitigated ≥ grade 2 toxicity (CTC AE 5.0) due to any prior treatment, excludingalopecia.
• With kinds of factors which affect oral medicine (e.g. failing to swallow,gastrointestinal tract getting resected, chronic diarrhea and ileus)
• Patients with pleural effusion or ascites.
• Patients with any severe and/or uncontrolled disease.
• Patients who underwent major surgery, open biopsy or significant traumatic injurywithin 4 weeks.
• Regardless of the severity, patients with any physical signs or history of bleeding,patients with bleeding or bleeding events greater than or equal to CTCAE 2 within fourweeks prior to the first administration, or patients with unhealed wounds, fractures,ulcers.
• Patients with arterial or venous thromboembolic events occurred within 6 months, suchas cerebrovascular accident (including transient ischemic attack), deep veinthrombosis and pulmonary embolism.