How I treat medullary thyroid cancer

Area of Science:

• Oncology
• Endocrinology
• Genetics

Background:

• Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor of thyroid C-cells.
• While localized MTC is surgically curable, recurrence rates are high, and many patients present with metastatic disease.
• Effective management necessitates a multidisciplinary approach, including surveillance and early medical oncology input.

Purpose of the Study:

• To provide a practical overview of the clinical presentation and management of MTC.
• To discuss the role of oncogenic pathways and targeted therapies in MTC treatment.
• To cover the spectrum of MTC management from early-stage to advanced disease.

Main Methods:

• Review of current literature on MTC pathogenesis, clinical presentation, and treatment strategies.
• Analysis of approved therapies, including multi-tyrosine kinase inhibitors and specific RET inhibitors.
• Synthesis of information on multidisciplinary care and surveillance protocols.

Main Results:

• Vascular endothelial growth factor receptor, epidermal growth factor receptor, MET, and RET pathways are implicated in MTC pathogenesis.
• Vandetanib and cabozantinib are approved for advanced MTC.
• Specific RET inhibitors demonstrate high response rates with reduced off-target toxicities.

Conclusions:

• Targeted therapies, particularly RET inhibitors, offer significant advancements in treating advanced MTC.
• A multidisciplinary approach is crucial for optimizing patient outcomes in MTC.
• Ongoing research continues to refine the understanding and treatment of MTC.