About RET+ Advanced Thyroid Cancer

Utilize biomarker testing in advanced thyroid cancers to determine appropriate treatment for your patients

There are several types of thyroid cancer, but most are differentiated thyroid cancers18,19

Thyroid cancers are classified according to the types of cells from which they originate. The cell type can help to determine prognosis, as well as clinical management of the disease.18,19

Thyroid types chart

There are less common types of thyroid cancer, such as lymphomas, sarcomas, and other rare tumors.18

Biomarkers are known to drive oncogenic growth in papillary thyroid cancer3,20-25

Differentiated thyroid cancer (DTC)

RET fusionsNTRK
rearrangements
BRAF v600E
mutations
ALK
fusions
ALL PTC~10%-20%20-22~2%-3%23~45%3~1%-3%24
PTC
(≤18 years of age)
~22%25~26%25~48%25

ALK=anaplastic lymphoma kinase; BRAF=B-Raf proto-oncogene; neoplasia type 2; NTRK=neurotrophic tyrosine receptor kinase; PTC=papillary thyroid cancer; RET+=rearranged during transfection positive.


Test for RET in Advanced Thyroid Cancer

Comprehensive biomarker testing is important in advanced thyroid cancers due to the prevalence of actionable biomarkers3,20,23

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend genomic testing to identify actionable mutations for structurally persistent/recurrent locoregional or distant metastatic DTC not amenable to radioiodine therapy that is advanced, progressive or threatening3

  • Somatic testing includes RET fusions, ALK fusions, NTRK fusions, BRAF mutations, dMMR/MSI, and TMB3

DNA- or RNA-based comprehensive profiling may be appropriate.26

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

RET alterations can be identified via various testing methodologies, including NGS, PCR, and FISH20

It is important to consider that not every laboratory test can detect RET fusions.

Talk to your pathologist to determine the most appropriate lab for testing your patient for biomarkers.

dMMR/MSI=mismatch repair deficient/microsatellite instability-high; DTC=differentiated thyroid cancer; FISH=fluorescence in situ hybridization; NCCN=National Comprehensive Cancer Network® (NCCN®); NGS=next-generation sequencing; PCR=polymerase chain reaction; RET+=rearranged during transfection positive; TMB=tumor mutational burden.

The treatment landscape for advanced thyroid cancer is evolving

Prior to 2020, multikinase inhibitors were approved for the treatment of certain thyroid cancers, but none were specifically approved for a RET+ biomarker-defined patient population.20 With the approval of RET-directed inhibitors, healthcare providers can utilize strategies to specifically target RET as an actionable biomarker in certain advanced thyroid cancers.1,27

Select patients for treatment based on the presence of a RET gene fusion. Consider a selectively designed RET inhibitor.1

An FDA-approved test for the detection of RET gene fusions is not currently available.

Efficacy data for GAVRETO
See RET+ advanced thyroid cancer data

Uncover the results for patients treated with a RET inhibitor.

GAV_THR-24003 0924

References:

 

1. GAVRETO® [Package insert], South San Francisco, CA: Rigel Pharmaceuticals, Inc.

 

3. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Thyroid Carcinoma V.3.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed July 2, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org.

 

18. American Cancer Society. Thyroid Cancer. https://www.cancer.org/cancer/thyroid-cancer/about/what-is-thyroid-cancer.html. Accessed May 7, 2024.

 

19. National Cancer Institute. Thyroid cancer treatment (adult) (PDQ®)–health professional version. https://www.cancer.gov/types/thyroid/hp/thyroid-treatment-pdq. Accessed May 7, 2024.

 

20. Drilon A, Hu ZI, Lai GGY, Tan DSW. Targeting RET-driven cancers: lessons from evolving preclinical and clinical landscapes. Nat Rev Clin Oncol. 2018;15(3):151-167.

 

21. Kato S, Subbiah V, Marchlik E, Elkin SK, Carter JL, Kurzrock R. RET aberrations in diverse cancers: next generation sequencing of 4,871 patients. Clin Cancer Res. 2017;23(8):1988-1997.

 

22. Santoro M, Porta GP, Berger N, et al. Ret oncogene activation in human thyroid neoplasms is restricted to the papillary cancer subtype. J Clin Invest. 1992;89(5):1517-1522.

 

23. Lee YC, Chen JY, Huang CJ, et al. Detection of NTRK1/3 rearrangements in papillary thyroid carcinoma using immunohistochemistry, fluorescent in situ hybridization, and next-generation sequencing. Endocr Pathol. 2020;31(4):348-358.

 

24. Panebianco F, Nikitski AV, Nikiforova MN, et al. Characterization of thyroid cancer driven by known and novel ALK fusions. Endocr Relat Cancer. 2019;26(11):803-814.

 

25. Prasad ML, Vyas M, Horne MJ, et al. NTRK fusion oncogenes in pediatric papillary thyroid carcinoma in Northeast United States. Cancer. 2016:1097-1107.

 

26. Belli C, Penault-Llorca F, Norman N, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021;32(3):337-350.

 

27. US Food & Drug Administration. In: Orange Book: Approved Drug Products With Therapeutic Equivalence Evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/results_product.cfm?Appl_Type=N&Appl_No=213246#37862. Accessed May 7, 2024.