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Is peptide receptor radionuclide therapy still a promising option for medullary thyroid carcinoma?
Fernanda Accioly de Andrade1, Daniel Bulzico1,2, Rossana Corbo1,2
1Endocrine Oncology Unit, Brazilian National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Abstract:
Medullary thyroid carcinoma (MTC) is a rare cancer that originates from germline RET proto-oncogene mutations in all hereditary forms and from somatic RET mutations in most sporadic cases. Currently, highly selective RET inhibitors have been approved for clinical use in patients with RET mutations with persistent, recurrent or metastatic disease. This therapy has proven efficacy, low toxicity, and a limited impact on patients' quality of life. However, for recurrent or metastatic RET-negative disease, few systemic therapies are available. Multikinase inhibitors are used; however, tumour cells frequently develop resistance mechanisms, or treatment must be discontinued due to the high incidence of side effects. In this context, peptide receptor radionuclide therapy (PRRT) may be a treatment option, but its clinical utility remains under investigation. The aim of this review is to evaluate the evidence of PRRT in MTC and discuss its limitations in the RET inhibitor era.
Insights
Medullary thyroid carcinoma (MTC) treatment advances with RET inhibitors for RET-mutated cancers. Peptide receptor radionuclide therapy (PRRT) is explored for RET-negative MTC, offering a potential alternative when other options fail.
Area of Science:
- Oncology
- Endocrinology
- Nuclear Medicine
Background:
- Medullary thyroid carcinoma (MTC) often arises from RET proto-oncogene mutations.
- Selective RET inhibitors are effective for RET-mutated MTC but limited for RET-negative disease.
- Current therapies for RET-negative MTC have resistance issues and significant side effects.
Purpose of the Study:
- To review the evidence for peptide receptor radionuclide therapy (PRRT) in MTC.
- To discuss the limitations of PRRT in the context of emerging RET inhibitor therapies.
Main Methods:
- Literature review of studies on PRRT for MTC.
- Analysis of PRRT efficacy and safety data.
- Comparison of PRRT with existing MTC treatments.
Main Results:
- RET inhibitors show efficacy and low toxicity in RET-mutated MTC.
- Few effective systemic therapies exist for recurrent or metastatic RET-negative MTC.
- PRRT shows potential but requires further clinical investigation for MTC.
Conclusions:
- RET inhibitors represent a significant advancement for RET-mutated MTC.
- PRRT may offer a therapeutic option for RET-negative MTC, but its role needs further elucidation.
- The clinical utility of PRRT in MTC requires more evidence, especially considering the success of targeted therapies.
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