New therapeutic approaches to treat medullary thyroid carcinoma

@article{Schlumberger2008NewTA,
  title={New therapeutic approaches to treat medullary thyroid carcinoma},
  author={Martin Schlumberger and Francesca Carlomagno and Eric Baudin and Jean Michel Bidart and Massimo Santoro},
  journal={Nature Clinical Practice Endocrinology \&Metabolism},
  year={2008},
  volume={4},
  pages={22-32}
}
Medullary thyroid carcinoma (MTC) accounts for up to 8% of all thyroid cancers. Although primary surgery is curative in the vast majority of patients treated at an early stage, disease can persist or recur with deleterious effects on quality of life. Local and distant metastases can occur and are the major causes of mortality. Reoperation, embolization, and perhaps radiotherapy can improve the outcome for some patients who are not cured by primary surgery, but there is a need for novel… 
2012 European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer
TLDR
These 21 recommendations focus on MTC patients with distant metastases and a detailed follow-up protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials.
Management of Patients with Metastatic Medullary Thyroid Carcinoma: The Role for Systemic Therapy
TLDR
This chapter outlines a suggested approach to the use of systemic therapy in progressive metastatic MTC, which is a relative rarity of this tumor and the infrequent need for systemic therapy.
Alternative therapeutic approaches in the treatment of primary and secondary dedifferentiated and medullary thyroid carcinoma.
TLDR
I-meta-iodobenzylguanidine therapy is a noteworthy therapeutic approach in patients experiencing metastasized medullary thyroid carcinoma, raising the hope for better outcomes in these patients in future.
European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer
TLDR
These 21 recommendations focus on MTC patients with distant metastases and a detailed follow-up protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials.
Putative BRAF activating fusion in a medullary thyroid cancer
TLDR
The genomic profiles of two medullary thyroid cancers are described and the presence of a putative oncogenic BRAF fusion in one is reported and such alterations, previously observed in other malignancies and known targets of available drugs, can benefit patients who currently have no treatment options.
Targeted therapy in refractory thyroid cancer.
RET therapeutic targeting in medullary thyroid carcinoma: molecular mechanisms of resistance
TLDR
Gain of MAPK cascade signaling seems to be able to mediate escape from RET inibition in vitro, thus suggesting p90RSK as a promising molecular target to overcome resistance formation to RET TKIs.
Molecular genetics of medullary thyroid carcinoma: the quest for novel therapeutic targets.
TLDR
The data on the involvement of genes acting in the RET and RB1/TP53 pathways in MTC is reviewed, with a view to improving the efficacy of RET-targeted therapies.
Vandetanib for the treatment of patients with locally advanced or metastatic hereditary medullary thyroid cancer.
TLDR
It is demonstrated that vandetanib may provide an effective therapeutic option in patients with advanced hereditary MTC, a rare disease for which there has been no effective therapy.
Pretargeted radioimmunotherapy in the treatment of metastatic medullary thyroid cancer
TLDR
The most appropriate prognostic indicators and the most efficient imaging techniques for the selection of patients intended to be treated with pretargeted radioimmunotherapy (pRIT) are considered and the effectiveness and toxicity of this new therapeutic modality is analyzed.
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References

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TLDR
Imatinib therapy yielded no objective responses and induced considerable toxicity in patients with MTC, and patients with supplemented hypothyroidism or with recurrent nerve palsy are specifically at risk for serious adverse events and need special attention when treated with imatinib.
Vandetanib in metastatic hereditary medullary thyroid cancer: Follow-up results of an open-label phase II trial
TLDR
Vandetanib (ZD6474) is a once- daily oral oral agent that selectively targets RET, VEGFR and EGFR tyrosine kinases that are likely to contribute to tumor growth and metastasis in patients with hereditary thyroid cancer.
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TLDR
TACE should be considered for treating MTC patients with progressive and predominant liver metastasis, and preferably at an early stage during the course of metastatic disease.
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TLDR
Imatinib mesylate is well tolerated, no tumour remission was observed, only transient stable disease was achieved in some patients with advanced MTC, and the median duration of therapy was 8 months.
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TLDR
On the basis of the activity of cyclophosphamide, vincristine, and dacarbazine in other advanced neuroendocrine neoplasms, the authors tested the combination in patients with advanced MTC.
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PURPOSE No effective therapy is currently available for the management of patients with metastatic medullary thyroid carcinoma (MTC). The efficacy of pretargeted radioimmunotherapy (pRAIT) with
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TLDR
There was no difference in local/regional relapse free rate between patients receiving external radiation and those that did not, but in 40 high risk patients (microscopic residual disease, extraglandular invasion, or lymph node involvement), the local/Regional relapsefree rate was 86% at 10 years with postoperative external beam radiation.
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TLDR
It becomes strikingly obvious that inhibition of RET oncogene function can be a viable option for the treatment of MTC.
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