Advances in the Management of Medullary Thyroid Carcinoma: Focus on Peptide Receptor Radionuclide Therapy

Abstract

Effective treatment options in advanced/progressive/metastatic medullary thyroid carcinoma (MTC) are currently limited. As in other neuroendocrine neoplasms (NENs), peptide receptor radionuclide therapy (PRRT) has been used as a therapeutic option in MTC. To date, however, there are no published reviews dealing with PRRT approaches. We performed an in-depth narrative review on the studies published in this field and collected information on registered clinical trials related to this topic. We identified 19 published studies, collectively involving more than 200 patients with MTC, and four registered clinical trials. Most cases of MTC were treated with PRRT with somatostatin analogues (SSAs) radiolabelled with 90 yttrium (90Y) and 177 lutetium (177Lu). These radiopharmaceuticals show efficacy in the treatment of patients with MTC, with a favourable radiological response (stable disease, partial response or complete response) in more than 60% of cases, coupled with low toxicity. As MTC specifically also expresses cholecystokinin receptors (CCK2Rs), PRRT with this target has also been tried, and some randomised trials are ongoing. Overall, PRRT seems to have an effective role and might be considered in the therapeutic strategy of advanced/progressive/metastatic MTC.

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

“…There was a radiographic disease control rate of 62.4% (most with stable disease) with treatment discontinuation for toxicity in 1.3% of cases. 72 Lee and Kim published a 2020 meta-analysis evaluating PRRT in patients with thyroid cancer. Five articles assessed the radiological response of PRRT specifically in MTC.…”

Clinical Challenges in the Management of Neuroendocrine Tumors

“…The NIKE study group, which includes several endocrinologists with significant expertise in NET management, provided a contribution to this Special Issue in the form of a detailed, comprehensive literature review on the potential role of peptide receptor radionuclide therapy (PRRT) in the setting of patients with medullary thyroid carcinoma [ 10 ], reporting a disease control rate of 62.4%, a figure that is in agreement with data from gastro-entero-pancreatic NETs. Peptide receptor radionuclide therapy was also the main topic covered by the study from del Olmo-García and co-workers, who investigated, through the robust methodology of a systematic review, the real risk of a hormonal crisis after PRRT in patients with syndromic functioning NETs or paraganglioma.…”

Challenges and future options for the production of lutetium-177

“…PRRT using 177 Lu-DOTATATE is now a regular EMA/FDAapproved therapy, with proven efficacy for patients with metastatic or unresectable NETs [14]. 177 Lu-DOTATATE therapy is currently also explored for several other tumour types, including for example melanoma, merkel cell carcinoma, esthesioneuroblastoma, thyroid cancer and malignant meningioma [15][16][17][18][19].…”