title: Medullary thyroid cancer in the era of tyrosine kinase inhibitors: to treat or not to treat--and with which drug--those are the questions.
abstract: BACKGROUND
  Medullary thyroid cancer (MTC) is a rare form of thyroid cancer comprising approximately 4% of all thyroid cancers. The majority of patients have a relatively good prognosis; however, a subgroup of patients will require systemic therapy. Large phase III randomized trials led to the approval of two drugs--vandetanib and cabozantinib--for progressive or symptomatic MTC. The decision regarding which drug to initiate first is not entirely clear and is a common concern amongst treating physicians.
  
  
  METHODS
  A review of the literature in English was conducted, and data were summarized and integrated into a decision matrix.
  
  
  CONCLUSIONS
  The decision regarding which drug to initiate first for progressive MTC should be based on a careful review of the medical history, physical examination findings, medication list, electrocardiogram, laboratory results, and tumor characteristics. It is necessary to consider the relative contraindications when choosing which drug to initiate first.
authors.affiliation: Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Cabanillas
authors.forename: Mimi I
authors.initials: MI
authors.lastname: Hu
authors.forename: Camilo
authors.initials: C
authors.lastname: Jimenez
mesh_terms: D000813:Anilides / Q000009:adverse effects / Q000627:therapeutic use; D018278:Carcinoma, Neuroendocrine; D004252:DNA Mutational Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use; D057285:Precision Medicine; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D000813:Anilides; D010880:Piperidines; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D011799:Quinazolines; C558660:cabozantinib; D011505:Protein-Tyrosine Kinases; C452423:vandetanib