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Lars Bastholt Department of Oncology R, Odense University Hospital, Odense, Denmark

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Michael C. Kreissl Department of Nuclear Medicine, Augsburg Hospital, Augsburg
Department of Nuclear Medicine, University Hospital Würzburg, Würzburg

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Dagmar Führer Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany

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Ana L. Maia Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre

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Laura D. Locati Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan

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Léa Maciel Hospital das Clínicas de Ribeirăo Preto, Ribeirăo Preto, Brazil

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Yi Wu Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

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Kevin N. Heller AstraZeneca, Gaithersburg, Md., USA

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Alan Webster AstraZeneca, Macclesfield, UK

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Rossella Elisei Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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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

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Camille Buffet Department of Thyroid Pathologies and Endocrine Tumors, AP-HP, Pitié-Salpêtrière Hospital, Groupe de Recherche Clinique n°16 Tumeurs Thyroïdiennes, Sorbonne Université, Paris, France
UMR9019, Genome Integrity and Cancers, CNRS, Villejuif, France

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Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Institut, Villejuif, France

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Françoise Kraeber-Bodéré Nuclear Medicine Department, Université de Nantes, CHU de Nantes, CNRS, Inserm, CRCINA, Nantes, France
CHU Nantes/ICO, Saint-Herblain, France

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Caroline Bodet-Milin Nuclear Medicine Department, Université de Nantes, CHU de Nantes, CNRS, Inserm, CRCINA, Nantes, France
CHU Nantes/ICO, Saint-Herblain, France

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Laure Cabanes Department of Cardiology, APHP, Cochin Hospital, Paris, France
Université de Paris, Paris, France

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Anthony Dohan Radiology Department, Université de Paris, Paris, France
Department of Radiology, AP-HP, Hôpital Cochin, Paris, France

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Pascal Leprince Department of Thoracic and Cardiovascular Surgery, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France

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Martin Schlumberger UMR9019, Genome Integrity and Cancers, CNRS, Villejuif, France
Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Institute, Villejuif, France

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Olivier Huillard Université de Paris, Sorbonne Paris Cité, Paris, France
Department of Medical Oncology, AP-HP, Hôpital Cochin, Paris, France

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Lionel Groussin INSERM Unité 1016, CNRS UMR 8104, Institut Cochin, Paris, France
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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Zoe A. Efstathiadou Department of Endocrinology, “Hippokration” General Hospital of Thessaloniki, Thessaloniki, Greece

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Charalambos Tsentidis Department of Endocrinology, General Hospital of Nikaia “Agios Panteleimon”, Piraeus, Greece

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Alexandra Bargiota Department of Endocrinology, University of Thessaly, Larisa, Greece

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Vasiliki Daraki Department of Endocrinology, University Hospital of Crete, Heraklion, Greece

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Kalliopi Kotsa Department of Endocrinology, “Ahepa” Hospital, Aristotle University, Thessaloniki, Greece

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Georgia Ntali Department of Endocrinology, Diabetes and Metabolism, “Evangelismos” Hospital Athens, Athens, Greece

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Labrini Papanastasiou Department of Endocrinology and Diabetes Center, Athens General Hospital “G. Gennimatas”, Athens, Greece

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Stelios Tigas Department of Endocrinology, University of Ioannina, Ioannina, Greece

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Konstantinos Toulis Department of Endocrinology, 424 Military Hospital, Thessaloniki, Greece

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Kalliopi Pazaitou-Panayiotou Division of Endocrinology, Endocrine Oncology, Interbalkan Medical Center, Thessaloniki, Greece

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Maria Alevizaki Endocrine Unit, Department of Medical Therapeutics, School of Medicine, Kapodistrian University of Athens, Athens, Greece

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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

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Carla Colombo Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

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Daniele Ceruti Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Massimiliano Succi Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Simone De Leo Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Matteo Trevisan Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Claudia Moneta Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Laura Fugazzola Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
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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Grace Segall Eli Lilly and Company, Indianapolis, IN, USA

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Ravinder Singh Eli Lilly and Company, Indianapolis, IN, USA

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Min-Hua Jen Eli Lilly and Company, Indianapolis, IN, USA

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Isaac Sanderson Adelphi Real World, Bollington, UK

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Alex Rider Adelphi Real World, Bollington, UK

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Katie Lewis Adelphi Real World, Bollington, UK

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Urpo Kiiskinen Eli Lilly and Company, Indianapolis, IN, USA

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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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Marine Sitbon Pharmacy Department, Hospital Saint-Louis APHP, Paris, France

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Porhuoy Chou Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Seydou Bengaly Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Brigitte Poirot Department of Molecular Oncology, Saint-Louis Hospital (AP-HP), Université Paris Cité INSERM U 944, CNRS UMR 7212, Paris, France

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Marie Laloi-Michelin Department of Internal Medicine, Hospital Lariboisière APHP, Paris, France

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Laure Deville Pharmacy Department, Hospital Saint-Louis APHP, Paris, France

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Atanas Pachev Radiology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Ahouefa Kowo-Bille Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Clement Dumont Medical Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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Cécile N Chougnet Endocrine Oncology Department, Saint-Louis Hospital (AP-HP), Université Paris Cité, Paris, France

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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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Stéphane Bardet Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France

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Renaud Ciappuccini Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France

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Livia Lamartina Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France

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Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France

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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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Carla Gambale Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Alessandro Prete Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Chiara Romei Department of Diagnostic Imaging, Unit of Radiology, Pisa University Hospital, Pisa, Italy

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Alessandro Celi Department of Surgery, Medicine, Molecular Biology and Critical Care, Respiratory Pathophysiology Unit, Pisa University Hospital, Pisa, Italy

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Rossella Elisei Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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Antonio Matrone Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, Pisa, Italy

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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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M. Schlumberger Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave-Roussy and University Paris Sud, Villejuif, France

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L. Bastholt Department of Oncology, Odense University Hospital, Odense, Denmark

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H. Dralle Department of Surgery, Martin Luther University, Halle-Wittenberg Medical Faculty, Halle/Saale, Germany

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B. Jarzab MSC Memorial Cancer Center and Institute of Oncology, Gliwice, Poland

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F. Pacini Department of Endocrinologia, University of Siena, Siena, Italy

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J.W.A. Smit Department of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands

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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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Francesca Carlomagno Dipartimento di Biologia e Patologia Cellulare e Molecolare L. Califano, Università degli Studi di Napoli Federico II, Napoli, Italia

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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

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