RET M918T no carcinoma tireoideoide medular (CTM): selpercatinib superior a cabozantinib/va...
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| ID | BMA-RET-M918T-MTC |
|---|---|
| Tipo | Relevância terapêutica |
| Estado | reviewed 2026-04-27 | pending_clinical_signoff | actionability review required |
| Doenças | DIS-MTC |
| Fontes | SRC-CIVIC SRC-NCCN-CNS-2025 |
Fatos de ação
| Biomarcador | BIO-RET |
|---|---|
| Variante | M918T (somática ~50% MTC esporádica; linhagem germinativa = MEN2B) |
| Doença | DIS-MTC |
| Nível ESCAT | IA |
| Combinações recomendadas | selpercatinib monotherapy (preferred 1L per LIBRETTO-531), pralsetinib monotherapy |
| Contraindicated monotherapy | cabozantinib / vandetanib (inferior in LIBRETTO-531; reserve for selective-TKI failure or unavailability) |
| Resumo das provas | RET M918T in medullary thyroid carcinoma (MTC): selpercatinib superior to cabozantinib/vandetanib in 1L advanced MTC (LIBRETTO-531, Hadoux NEJM 2024 — PFS HR 0.28). Activity also in germline-driven MEN2B disease. Pralsetinib (ARROW) similarly active. Selective RET-TKIs are preferred over multikinase TKIs. |
Notas
ESCAT IA. OncoKB Level 1. SRC-NCCN-THYROID-2025 is not yet ingested — using SRC-NCCN-CNS-2025 as a placeholder for NCCN-derived guidance pending thyroid guideline ingestion (matches DIS-MTC source-gap flagging). Trial-source gap: SRC-LIBRETTO-531-WIRTH-2024 not yet ingested. Calcitonin doubling time <12 mo and structural progression are systemic-therapy triggers.
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