New therapeutic approaches to treat medullary thyroid carcinoma.
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 treatments. No comprehensive clinical trial data are available on conventional cytotoxic agents for the treatment of MTC. Patients with distant metastases, in particular, might benefit from several novel compounds directed against angiogenesis and molecular targets in tumor cells, such as products of the proto-oncogene RET and mutants of it, and other signaling components. Well-conducted clinical trials are needed to assess and optimize these treatment strategies, and this article outlines how such trials should be conducted. Although RET mutations are common in hereditary MTC and can occur in some cases of sporadic MTC, knowledge of other molecular defects associated with the development of MTC should reveal new targets for therapy.
Schlumberger
Martin
M
University Paris-Sud 11, Paris, France. schlumbg@igr.fr
Carlomagno
Francesca
F
Baudin
Eric
E
Bidart
Jean Michel
JM
Santoro
Massimo
M
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018276:Carcinoma, Medullary / Q000235:genetics / Q000628:therapy*; D003131:Combined Modality Therapy / Q000639:trends; D006801:Humans; D000090063:Proto-Oncogene Mas; D013964:Thyroid Neoplasms / Q000235:genetics / Q000628:therapy*; D013965:Thyroidectomy
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas