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Department of Nuclear Medicine, University Hospital Würzburg, Würzburg
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contribute to the growth and invasiveness of MTC [ 11 , 12 ]. Vandetanib is a once-daily oral multikinase inhibitor directed against VEGFR2, RET and EGFR [ 9 , 13 ]. In the EU, vandetanib is indicated for the treatment of aggressive and symptomatic MTC in
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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with long-term outcome under the tyrosine kinase inhibitor vandetanib. Patient 1 A 45-year-old woman was diagnosed with MTC after total thyroidectomy and neck dissection (Fig. 1 a). Histology revealed an 11-mm thyroid tumor with minimal extra
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vandetanib inhibit multiple kinases including RET and VEGFR. Among others, signaling pathways initiated by both RET and VEGFR are important for MTC development and progression [ 3 , 7 ]. Although promising, these drugs show only a modest effect on advanced
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Europe, the multikinase inhibitors sorafenib, lenvatinib (LEN) and cabozantinib have been approved for RAI-R DTC, vandetanib (VAN) and cabozantinib for MTC, and the gene-targeted selpercatinib (SELP) and larotrectinib for cancers harbouring rearranged
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recommend the MKIs cabozantinib and vandetanib as first-line systemic therapy, and the selective RET inhibitor selpercatinib for patients with RET mutation-positive MTC who require systemic therapy following prior treatment with cabozantinib and
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patients with familial MTC have a RET germline mutation ( 2 ). The gold-standard systemic treatment for metastatic MTC is vandetanib. Numerous intratumoral RET mutations exist, leading to heterogeneous phenotypes in terms of aggressiveness ( 3 ). The
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which recently proved as highly efficient and well-tolerated in phase 1–2 trial including RET -mutant MTC patients. The tumour response rate according to RECIST 1.1 was 69% in the 55 patients who had previously received vandetanib, cabozantinib, or both
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advanced/metastatic ( 1 ). According to European Medicines Agency (EMA) indications, two multikinase inhibitors (MKIs) (i.e. vandetanib and cabozantinib) and one highly selective RET inhibitor (i.e. selpercatinib) have been approved for the treatment of
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clinical trials, including axitinib, cabozantinib (XL-184), lenvatinib (E7080), motesanib, pazopanib, sorafenib, sunitinib and vandetanib [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. In phase II trials, several of these agents have demonstrated
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to their toxicity or limited bioavailability. Another group of anti-RET compounds that had been tested in phase I clinical trials has been described. Such molecules comprise vandetanib, sorafenib, sunitinib, cabozantinib and lenvatinib [ 40 , 41