Molecular predictive biomarker testing in advanced thyroid cancer - a European consensus

Area of Science:

• Oncology
• Genetics
• Endocrinology

Background:

• Precision oncology therapies are emerging for thyroid cancer (TC).
• Current European guidelines lack comprehensive molecular testing strategies for advanced TC.
• Standardized guidance is needed for targetable alterations, testing timing, and patient selection.

Purpose of the Study:

• To outline consensus molecular testing algorithms for differentiated, medullary, and anaplastic TC.
• To provide standardized recommendations for physicians treating advanced TC.
• To address comprehensive biomarker testing strategies, including timing and patient selection.

Main Methods:

• Expert opinion from endocrinologists, oncologists, molecular biologists, and pathologists.
• Development of consensus testing algorithms for different TC subtypes.
• Recommendations on tumor tissue use and centralization of molecular testing.

Main Results:

• Differentiated TC: Comprehensive DNA/RNA NGS for patients progressing on or resistant to radioactive iodine.
• Medullary TC: Universal RET germline testing; somatic RET NGS for high-risk or progressing disease.
• Anaplastic TC: Reflex BRAF mutation testing at diagnosis, followed by DNA/RNA NGS if BRAF-negative.

Conclusions:

• Standardized molecular testing algorithms are crucial for optimal treatment selection in advanced TC.
• Multidisciplinary input and centralized testing are recommended.
• These algorithms aim to guide physicians in navigating complex biomarker testing landscapes.