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Review
. 2023 Dec;24(12):1815-1832.
doi: 10.1007/s11864-023-01145-5. Epub 2023 Nov 18.

The Evolving Treatment Landscape of Medullary Thyroid Cancer

Marta Laganà  1 , Valentina Cremaschi  1 , Andrea Alberti  2 , Danica M Vodopivec Kuri  3 , Deborah Cosentini  1 , Alfredo Berruti  1
Affiliations
Review

The Evolving Treatment Landscape of Medullary Thyroid Cancer

Marta Laganà et al. Curr Treat Options Oncol. 2023 Dec.

Abstract

Genetic assessment is crucial to address the correct treatment for advanced medullary thyroid cancer (MTC). Multi tyrosine kinase inhibitors (mTKIs) cabozantinib and vandetanib are good first line options, even vandetanib prescription is currently limited to RET mutated patients. Selective RET inhibitors such as pralsetinib could be a preferred upfront treatment in case of RET mutated MTC presenting common or gatekeeper RET mutations (e.g. M918T; V804L/M). Selpercatinib, otherwise, can be prescribed as the second line after disease progression to mTKIs. The best option for subsequent lines is to consider inclusion in clinical trials or alternatively other mTKIs such as sunitinib, sorafenib, lenvatinib, or pazopanib could be evaluated. New perspectives include next-generation RET inhibitors able to overcome resistance mechanisms responsible for disease progression to standard mTKIs and RET inhibitors, and immunotherapy for MTC presenting with high tumor mutational burden.

Keywords: Cancer; Future options; Medullary thyroid; Metastatic MTC; MultiTKI; Pretreated MTC; RET inhibitors; RET mutations.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
RET- target drugs.
Fig. 2
Fig. 2
Flowchart treatment for metastatic disease in our Institution.
See this image and copyright information in PMC

References

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