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Dr. Wirth on questions about the use of selpercatinib in advanced RET-Fusion+ thyroid cancer

Dr. Wirth on questions about the use of selpercatinib in advanced RET-Fusion+ thyroid cancer
Dr. Wirth on questions about the use of selpercatinib in advanced RET-Fusion+ thyroid cancer

Lori Wirth, MD, associate professor of medicine at Harvard Medical School; medical director of the Center for Head and Neck Cancers at Massachusetts General Hospital, discusses remaining questions regarding the treatment of adult and pediatric patients aged 2 years or older with advanced or metastatic RET Fusion-positive thyroid cancer requiring systemic therapy and refractory to radioactive iodine after surgery in June 2024 Full FDA approval of selpercatinib (Retevmo).

The FDA’s full approval of selpercatinib for this indication underscores the drug’s position as a first-line treatment for RET-related thyroid cancer, whether RET-mutated medullary thyroid carcinomas or RET Fusion-positive thyroid cancers from follicular cells, for which radioactive iodine is not suitable, Wirth says. Selpercatinib is already recognized as a category 1 drug in the guidelines of the National Comprehensive Cancer Network for this indication, says Wirth. The full FDA approval underscores the drug’s priority status, she explains. Since solid data on safety and efficacy are now also available for pediatric patients, selpercatinib is also considered a primary treatment option for children with RET-related thyroid cancer, Wirth notes.

An important but still unresolved question in this area concerns the timing of initiating selpercatinib therapy, she continues. Because some thyroid cancers can be indolent and asymptomatic for long periods of time and older treatments such as multikinase inhibitors were associated with significant adverse events (AEs), clinicians often delayed therapy in the past to balance efficacy with quality of life (QOL), Wirth points out. The question now is whether it is still appropriate to delay treatment in patients with RET-related thyroid cancer, or whether earlier administration of selpercatinib in the course of the disease would lead to better outcomes, Wirth adds.

Determining the timing of treatment is critical because early intervention may improve long-term efficacy, but the optimal time to start selpercatinib treatment in asymptomatic or slowly progressing cases remains uncertain, she adds. Therefore, determining the best approach for timing selpercatinib therapy is an important consideration for clinicians treating patients with RET-driven thyroid cancer, Wirth emphasizes. The balance between controlling potential progression and maintaining quality of life without unnecessary delays in effective treatment is at the heart of ongoing discussions and research in this area, Wirth concludes.

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