Selpercatinib prior to radioactive iodine for pediatric papillary thyroid carcinoma
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Harvey K. Chiu
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Theodore S. Nowicki
Abstract
Objectives
We introduced selpercatinib prior to radioactive iodine therapy prior to radioactive iodine therapy (RAI) for pediatric papillary thyroid cancer (PTC) to enhance the tumorical effects of RAI.
Case presentation
PTC has an excellent prognosis but is commonly associated with local and distant metastases. Successful complete response to the current standard of care, thyroidectomy with lymph node resection and RAI, is achieved in only a small minority of cases with metastases. The direct effect of tyrosine kinase inhibitors (TKIs) on tumor regression has been confirmed in several randomized controlled studies, while the increased RAI uptake has been reported in small case series, but typically TKIs are currently reserved third-line. Selpercatinib is a TKI that specifically has a durable effect in RET-fusion positive malignancies. We describe a 10-year-old Hispanic girl with metastatic PTC treated with total thyroidectomy and extensive lymph node resection. Evaluation for relevant genetic drivers of the malignancy revealed a strong overexpression of the RET tyrosine kinase domain indicative of a RET gene fusion. Selpercatinib 120 mg twice daily given orally was initiated prior to the initial dose of RAI to achieve further tumor regression by a direct cytostatic effect and then secondarily enhancement of RAI uptake. Minimal side effects occurred, specifically intermittent mild skin rashes that resolved. Resolution of distal lung metastases was noted on CT imaging. RAI was then administered 9 months afterward, with ultimately achievement of a low thyroglobulin level 1.0 ng/mL 11 months after RAI.
Conclusions
In conclusion, selpercatinib given prior to the initial dose of adjunctive RAI for RET-fusion positive PTC is a well-tolerated intervention that further reduces tumor burden and potentially enhances the tumorcidal effects of RAI.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
References
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Artikel in diesem Heft
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- Selpercatinib prior to radioactive iodine for pediatric papillary thyroid carcinoma
Artikel in diesem Heft
- Frontmatter
- Review
- Selecting optimal progestational agents either alone or in combination in common pediatric endocrine settings: challenges of unmet needs
- Original Articles
- Comparison of the effectiveness of prepubertal growth hormone treatment on height and predicted adult height in children with short stature born small for gestational age vs. with a growth hormone deficiency
- Expanded phenotypic spectrum in MODY 5 patients with 17q12 deletion syndrome: experience from an Indian tertiary care hospital
- Endocrine sequelae after pediatric craniopharyngioma treatment: a single-center retrospective cohort study
- Premature ovarian insufficiency in pediatric cancer patients: a 10 year Rady Children’s Hospital experience
- Alterations in optical coherence tomography and optical coherence tomography angiography findings in children with partial biotinidase deficiency
- Slow growth and short stature in children with attention deficit hyperactivity disorder (ADHD): a retrospective study of 493 children who underwent growth hormone provocation testing at one tertiary paediatric endocrine centre
- Short Communication
- Assessment of diabetes-specific knowledge and its determinants among children with type 1 diabetes mellitus and their primary caregivers: Experience from a tertiary care center in North India
- Letters to the Editor
- Comment on “Diagnostic utility of the average peak LH levels measured during GnRH stimulation test”
- Author’s reply “Comment on diagnostic utility of the average peak LH levels measured during GnRH stimulation test”
- Case Reports
- Estrogen-insensitivity syndrome (EIS) in a female adolescent patient – a case report
- The complexities of managing a newborn with 6q24 transient neonatal diabetes mellitus: a case report
- Homozygous mutation of KISS1 receptor (KISS1R) gene identified in a Chinese patient with congenital hypogonadotropic hypogonadism (CHH): case report and literature review
- Selpercatinib prior to radioactive iodine for pediatric papillary thyroid carcinoma
