[Expert consensus on adverse events management of highly selective RET-TKIs (2026 edition)]

The rearranged during transfection (RET) gene is a proto-oncogene encoding a receptor tyrosine kinase. RET gene alterations are driver events in various tumors. Pralsetinib and selpercatinib are novel, highly selective RET tyrosine kinase inhibitors (RET-TKIs). They are recommended as priority therapeutic options for RET fusion-positive non-small cell lung cancer (NSCLC) in the Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Non-Small Cell Lung Cancer and Thyroid Carcinoma and the Chinese Medical Association (CMA) Clinical Guidelines for Lung Cancer, as well as for radioiodine-refractory differentiated thyroid cancer with RET fusion and RET-mutant medullary thyroid carcinoma. Common adverse events asosociated with pralsetinib and selpercatinib include hypertension, liver enzyme abnormalities, neutropenia and fatigue. Studies have demonstrated that the incidence of adverse events is not associated with disease type. Given the low prevalence of RET gene alterations (＜5%), which are regarded as rare genetic mutations, clinical experience in the use pf RET-TKIs and and patient management remains limited. Base on the current status of adverse event management of RET-TKIs in China, and integrating the latest international evidence and clinical experience, the Chinese Medical Doctor Association Tumor Multidisciplinary Diagnosis and Treatment Professional Committee and the Shenzhen Medical Doctor Association Tumor Multidisciplinary Diagnosis and Treatment Professional Committee organized discussion among experts from medical oncology, respiratory medicine, radiation oncology, thoracic surgery, and other related disciplines to formulate this expert consensus on the management of adverse events of RET-TKIs.