[Systemic therapies for advanced thyroid cancer - an update].

Area of Science:

• Oncology
• Pharmacology
• Clinical Medicine

Background:

• Four multi-kinase inhibitors (MKIs) are approved for progressive radioiodine-refractory differentiated thyroid carcinoma (rrDTC) and medullary thyroid carcinoma (MTC) in Germany.
• Cabozantinib recently gained approval as a second-line treatment for advanced rrDTC based on the COSMIC-311 trial.
• Selpercatinib, a selective RET-inhibitor, demonstrates efficacy in advanced MTC and rrDTC with RET alterations.

Purpose of the Study:

• To summarize recent advancements in the treatment of advanced thyroid carcinoma (ATC).
• To highlight new therapeutic options and guideline changes for ATC.
• To provide an overview of approved multi-kinase inhibitors and novel agents in thyroid cancer treatment.

Main Methods:

• Review of phase III clinical studies and recent trial data (e.g., COSMIC-311).
• Analysis of approved multi-kinase inhibitors (MKIs) for rrDTC and MTC.
• Evaluation of Selpercatinib's efficacy and safety profile in advanced MTC and rrDTC.

Main Results:

• Cabozantinib is approved as a second-line therapy for advanced rrDTC.
• Selpercatinib shows promising efficacy and a favorable side effect profile in first-line advanced MTC (RET mutations) and second-line rrDTC (RET fusions).
• Current ATA guidelines reflect changes and new approaches in ATC treatment.

Conclusions:

• The treatment landscape for advanced thyroid carcinoma has expanded with new MKI approvals and novel agents like Selpercatinib.
• Targeted therapies, including RET inhibitors, offer improved outcomes for specific patient populations with MTC and rrDTC.
• Updated clinical guidelines incorporate these advancements, guiding therapeutic decisions for ATC.