甲状腺髓样癌:最新进展和挑战。

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Matti L Gild, Roderick J Clifton-Bligh, Lori J Wirth, Bruce G Robinson
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引用次数: 2

摘要

个性化的方法来管理甲状腺髓样癌(MTC)提出了几个挑战;然而,在过去十年中,在诊断和治疗方式方面取得了重大进展。多种内分泌肿瘤2型和3型的生殖系重排转染(RET)检测以及散发性MTC的体细胞RET检测彻底改变了患者的治疗选择。新型放射配体的正电子发射断层成像改善了疾病的表征,新的国际分级系统可以预测预后。持续性和转移性疾病的全身治疗随着靶向激酶治疗的发展而显著发展,特别是对于那些携带种系或体细胞RET变异的疾病。Selpercatinib和pralsetinib是高度选择性的RET激酶抑制剂,与早期的多激酶抑制剂研究相比,它们已显示出改善的无进展生存期和更好的耐受性。在这里,我们讨论了MTC患者模式的变化:从预先确定RET改变状态到评估这种异质性疾病的新技术。使用激酶抑制剂的成功和挑战将说明如何管理这种罕见的恶性肿瘤继续发展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medullary Thyroid Cancer: Updates and Challenges.

A personalized approach to the management of medullary thyroid cancer (MTC) presents several challenges; however, in the past decade significant progress has been made in both diagnostic and treatment modalities. Germline rearranged in transfection (RET) testing in multiple endocrine neoplasia 2 and 3, and somatic RET testing in sporadic MTC have revolutionized the treatment options available to patients. Positron emission tomography imaging with novel radioligands has improved characterization of disease and a new international grading system can predict prognosis. Systemic therapy for persistent and metastatic disease has evolved significantly with targeted kinase therapy especially for those harboring germline or somatic RET variants. Selpercatinib and pralsetinib are highly selective RET kinase inhibitors that have shown improved progression-free survival with better tolerability than outcomes seen in earlier multikinase inhibitor studies. Here we discuss changes in paradigms for MTC patients: from determining RET alteration status upfront to novel techniques for the evaluation of this heterogenous disease. Successes and challenges with kinase inhibitor use will illustrate how managing this rare malignancy continues to evolve.

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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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