Selpercatinib: Revolutionizing the Treatment of Thyroid Cancer
Selpercatinib, also known as Retevmo®, has been making waves in the field of oncology since its FDA approval in 2020 for the treatment of RET-related lung cancer and thyroid cancers in patients 12 and older. Recently, on June 12, 2024, the US Food and Drug Administration (FDA) granted full approval to selpercatinib for the treatment of adult and pediatric patients 2 years and older with advanced or metastatic thyroid cancers that have certain changes in a gene called RET. One of the key players in the development of selpercatinib for thyroid cancer is Eric Sherman, MD, head and neck medical oncologist from Memorial Sloan Kettering Cancer Center (MSK).
The Science behind Selpercatinib
Some thyroid cancers have what are called RET fusions, where part of the gene RET gets rearranged and attaches itself to another gene. Selpercatinib is designed to target and block the RET protein that drives the growth of these abnormal cells.
RET fusions are found in about 10 percent of thyroid tumors that originate in follicular cells, such as anaplastic thyroid cancer which is the most aggressive and difficult-to-treat form of the disease. Another type of thyroid tumor, called medullary cancer, has a different kind of change to the RET gene. Rather than a fusion, it has a mutation, or change in the gene’s sequence. RET mutations are found in more than half of all medullary thyroid cancers. Since selpercatinib works on both types of RET mutations, it is a significant breakthrough in the field of oncology.
Benefits of Selpercatinib
Selpercatinib is a targeted therapy and is designed to be very specific at blocking the RET protein, and only the RET protein. Unlike earlier drugs shown to block RET, such as cabozantinib and vandetanib, selpercatinib has fewer side effects since it is much cleaner than its predecessors. This is because it doesn’t hit many different protein targets. Therefore, selpercatinib is a much more effective and efficient drug, and can be given at higher doses.
Treatment Options for Thyroid Cancer
It is important to note that not all patients with thyroid cancer need targeted therapies like selpercatinib. When tumors are detected early, they can often be successfully treated with surgery to remove part or all of the thyroid gland and radioactive iodine therapy, or a combination of the two. Some patients may not need any of these treatments at all and may instead choose active surveillance, which means the cancer is carefully monitored with scans and other tests.
Nonmedullary thyroid cancer (for example, papillary thyroid cancer) may have other gene alterations that can be targeted in a similar fashion with targeted therapies. The most common gene that’s implicated in thyroid cancers is BRAF. Drugs that target BRAF may be used to treat thyroid cancer, either alone or in combination with other drugs. Additionally, thyroid cancers caused by gene changes called NTRK fusions can be treated with drugs that target those mutations. MSK researchers are actively investigating ways to treat other types of mutations or molecular changes that can be found in thyroid cancers as well.
The Future of Treating Thyroid Cancer
Thanks to MSK-IMPACT®, the molecular test that looks for mutations in more than 500 cancer-related genes, patients can be matched with the best targeted therapies for their cancers. The sequencing of every advanced thyroid cancer through MSK-IMPACT can aid researchers in identifying changes that drive these cancers, which will lead to more treatments in the future.
Conclusion
Selpercatinib is a significant breakthrough in the field of oncology, providing targeted therapy to treat thyroid cancers. Patients who experience abnormal growth of cells that are linked to the RET gene can now have hope for an effective treatment option. MSK researchers are continuing to investigate the use of targeted therapies to treat other types of mutations, paving the way for a brighter future for cancer patients.
Originally Post From https://www.mskcc.org/news/targeted-therapy-selpercatinib-receives-full-fda-approval-to-treat-ret-linked-thyroid
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