Fundamentals and recent advances in the evaluation and management of medullary thyroid carcinoma

Abstract

Medullary thyroid carcinoma (MTC) is a rare primary neuroendocrine thyroid carcinoma that is distinct from other thyroid or neuroendocrine cancers. Most cases of MTC are sporadic, although MTC exhibits a high degree of heritability as part of the multiple endocrine neoplasia syndromes. REarranged during Transfection (RET) mutations are the primary oncogenic drivers and advances in molecular profiling have revealed that MTC is enriched in druggable alterations. Surgery at an early stage is the only chance for cure, but many patients present with or develop metastases. C-cell-specific calcitonin trajectory and structural doubling times are critical biomarkers to inform prognosis, extent of surgery, likelihood of residual disease, and need for additional therapy. Recent advances in the role of active surveillance, regionally directed therapies for localized disease, and systemic therapy with multi-kinase and RET-specific inhibitors for progressive/metastatic disease have significantly improved outcomes for patients with MTC.

Keywords: Calcitonin; Calcitonin doubling time; Carcinoembryonic antigen; Embolization; External beam radiation therapy; Immunotherapy; Medullary thyroid carcinoma; Modified radical neck dissection; Multi-kinase inhibitors; Neuroendocrine tumor; Next generation sequencing; Peptide receptor radionuclide therapy; Positron emission tomography; RET inhibitor resistance; RET inhibitors; Rearranged during transfection (RET); Thermal ablation; Thyroid cancer; Thyroidectomy; Tyrosine kinase inhibitors.