Management of Advanced Medullary Thyroid Carcinoma

Abstract

Thyroid cancer is a common endocrine tumor that is somewhat on the increase in the United States. Medullary thyroid carcinomas are relatively uncommon thyroid malignancies. Despite the fact that medullary thyroid carcinoma is considered to be a rare disease, it is the subject of prolific research activity. Approximately three-fourths of cases of medullary thyroid carcinoma are sporadic, one-fourth is hereditary and may be a part of a multiple endocrine neoplasia 2A, 2B or a familial medullary thyroid carcinoma without associated endocrinopathies. Altered molecular pathways in tumoral cells contribute to the progression of the disease. There is no curative treatment for advanced medullary thyroid carcinoma. Currently, two new multi-tyrosine kinase inhibitors have been approved by the United States Food and Drug Administration and the European Medicines Agency. Both are recommended for the systemic treatment of selected patients with MTC. Patients who cannot benefit from multi-tyrosine kinase inhibitors could be incorporated in clinical trials using other targeted therapies. The over-expression of cholecystokinin type “brain” receptors, renamed by an International Union of Pharmacology committee as cholecystokinin type 2 receptors, was found in medullary thyroid carcinoma. Because of the fact that scintigraphy or positron emission tomography scans and peptide receptor radionuclide therapy match these type of receptors, they could be used in alternative diagnostic procedures and targeted therapy.