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Established facts Selpercatinib, a highly selective RET inhibitor, has demonstrated notable efficacy in advanced/progressive RET-mutant medullary thyroid cancer patients. Despite a more tolerable toxicity profile than multikinase
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Introduction Medullary thyroid cancer (MTC) is a neuroendocrine tumor arising from parafollicular or calcitonin-producing C cells that retain the biochemical and pathological features of the cells from which it derives. MTC accounts for 3
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Introduction Medullary thyroid cancer (MTC) is a rare neuroendocrine tumour derived from calcitonin-secreting parafollicular C cells ( 1 ) and accounts for approximately 2‒4% of thyroid cancers ( 2 , 3 , 4 , 5 ) but up to 15% of thyroid
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Methods of Development of Evidence-Based Guidelines The European Thyroid Association (ETA) Executive Committee launched a taskforce to produce guidelines on the treatment of metastatic medullary thyroid cancer (MTC). A chairperson was selected
UMR9019, Genome Integrity and Cancers, CNRS, Villejuif, France
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CHU Nantes/ICO, Saint-Herblain, France
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CHU Nantes/ICO, Saint-Herblain, France
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Université de Paris, Paris, France
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Department of Radiology, AP-HP, Hôpital Cochin, Paris, France
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Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Institute, Villejuif, France
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Department of Medical Oncology, AP-HP, Hôpital Cochin, Paris, France
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Université de Paris, Paris, France
Department of Endocrinology, AP-HP, Hôpital Cochin, Paris, France
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from medullary thyroid cancers (MTC) are uncommon. Their frequency in large autopsy series in patients with thyroid cancers is low, between 0 and 5% [ 1 - 5 ]. Given the rarity of this metastatic location, the outcome remains unclear. The average length
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Introduction Several guidelines have already been published on the diagnosis, management, and treatment of medullary thyroid cancer (MTC) [ 1 , 2 , 3 , 4 ], but there are no guidelines devoted specifically to RET genetic screening in
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Department of Nuclear Medicine, University Hospital Würzburg, Würzburg
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Introduction Medullary thyroid cancer (MTC) is a malignancy of the parafollicular C cells of the thyroid gland, and it accounts for an estimated 4% of thyroid cancers [ 1 , 2 ]. MTC can only be cured by surgery and, until recently, the
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Introduction Medullary thyroid cancer (MTC) originates from parafollicular C-cells and represents 2% of all thyroid malignancies and 0.4–1.4% of all thyroid nodules ( 1 ). MTC is sporadic in 75–80% of cases or manifests as a hereditary tumor
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Introduction Medullary thyroid cancer (MTC) is a rare variant of thyroid cancer with different aetiology, presentation, treatment and symptoms compared to the more common differentiated thyroid cancers (DTC). Based on Cancer Research UK (CRUK
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Introduction
Serum calcitonin (CT) and carcinoembryonic antigen (CEA) are valuable tumour markers in patients with medullary thyroid carcinoma (MTC). Both markers most often evolve in parallel after treatment. Selpercatinib (LOXO-292) is a highly selective RET kinase inhibitor indicated in advanced RET-mutant MTC patients.
Cases presentation
In this study, we report two observations of RET-mutant progressive metastatic and symptomatic MTC patients who were treated with selpercatinib. Patient 1, a 61-year-old man, presented dyspnoea and diarrhoea at selpercatinib initiation with large neck lymph nodes and lung metastases. Patient 2, a 76-year-old man, had acute discomfort with flush and diarrhoea, with small but diffuse bone and liver disease. Both patients had an objective tumour response with rapid clinical improvement and RECIST 1.1 response (−90%) in patient 1. A rapid dramatic decrease in CT level was observed in both patients (−99% in both patients), while CEA levels gradually and sustainably increased after selpercatinib initiation (+207% at cycle 15 in patient 1 and + 835% at cycle 14 in patient 2). In both patients, 18FDG PET/CT did not show any abnormal uptake that could explain the CEA increase. Colonoscopy and oesogastric fibroscopy showed colonic polyposis with mild oesophagitis and gastritis in patient 1 and were normal in patient 2.
Conclusion
These observations show an unusual and lasting increase in serum CEA in two MTC patients who exhibited an objective tumour response to selpercatinib. The mechanism behind this unexpected rise in CEA level remains unknown. The frequency of this evolving profile will be determined in further phase III studies.