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Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma

The endocrine secretions of carcinomas can be life-threatening. Medullary thyroid carcinoma (MTC) is a rare cancer that is often associated with cortisol secretion, leading to paraneoplastic Cushing’s syndrome. Mutations of the proto-oncogene RET are driver molecular events in 70% of MTC cases. Here...

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Autores principales: Sitbon, Marine, Chou, Porhuoy, Bengaly, Seydou, Poirot, Brigitte, Laloi-Michelin, Marie, Deville, Laure, Pachev, Atanas, Kowo-Bille, Ahouefa, Dumont, Clement, Chougnet, Cécile N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578062/
https://www.ncbi.nlm.nih.gov/pubmed/36069795
http://dx.doi.org/10.1530/ETJ-22-0032
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author Sitbon, Marine
Chou, Porhuoy
Bengaly, Seydou
Poirot, Brigitte
Laloi-Michelin, Marie
Deville, Laure
Pachev, Atanas
Kowo-Bille, Ahouefa
Dumont, Clement
Chougnet, Cécile N
author_facet Sitbon, Marine
Chou, Porhuoy
Bengaly, Seydou
Poirot, Brigitte
Laloi-Michelin, Marie
Deville, Laure
Pachev, Atanas
Kowo-Bille, Ahouefa
Dumont, Clement
Chougnet, Cécile N
author_sort Sitbon, Marine
collection PubMed
description The endocrine secretions of carcinomas can be life-threatening. Medullary thyroid carcinoma (MTC) is a rare cancer that is often associated with cortisol secretion, leading to paraneoplastic Cushing’s syndrome. Mutations of the proto-oncogene RET are driver molecular events in 70% of MTC cases. Here, we report a case of a woman, born in 1956, who was diagnosed with sporadic MTC in 2005, with subsequent relapses treated with focal treatments. In April 2019, she presented with severe and rapidly progressive paraneoplastic Cushing’s syndrome associated with lymph node, lung, liver and bone metastases. A supraclavicular lymph node biopsy revealed a somatic p.M918T (c.2753T>C) mutation in exon 16 of the RET proto-oncogene. The patient began treatment with selpercatinib in September 2019. Clinical efficacy was immediate. Chronic diarrhea disappeared within a few days. Clinical hypercorticism quickly disappeared, with quick improvements in muscle and skin conditions and fatigue. Two months after treatment initiation, urinary free cortisol normalized to 42 µg/24 h. Levels of the tumor markers carcinoembryonic antigen (CEA) and calcitonin also greatly decreased from baseline. After 34 months of treatment, selpercatinib elicits sustained clinical, biological and morphological responses. In summary, this case report illustrates the rapid and long-lasting antisecretory effect of selpercatinib associated with tumor control. As Cushing’s syndrome associated with medullary thyroid cancer is associated with poor prognosis, this case report is very encouraging. In addition, this suggests the potential benefit of molecular testing in all cases of medullary thyroid cancer.
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spelling pubmed-95780622022-10-18 Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma Sitbon, Marine Chou, Porhuoy Bengaly, Seydou Poirot, Brigitte Laloi-Michelin, Marie Deville, Laure Pachev, Atanas Kowo-Bille, Ahouefa Dumont, Clement Chougnet, Cécile N Eur Thyroid J Case Report The endocrine secretions of carcinomas can be life-threatening. Medullary thyroid carcinoma (MTC) is a rare cancer that is often associated with cortisol secretion, leading to paraneoplastic Cushing’s syndrome. Mutations of the proto-oncogene RET are driver molecular events in 70% of MTC cases. Here, we report a case of a woman, born in 1956, who was diagnosed with sporadic MTC in 2005, with subsequent relapses treated with focal treatments. In April 2019, she presented with severe and rapidly progressive paraneoplastic Cushing’s syndrome associated with lymph node, lung, liver and bone metastases. A supraclavicular lymph node biopsy revealed a somatic p.M918T (c.2753T>C) mutation in exon 16 of the RET proto-oncogene. The patient began treatment with selpercatinib in September 2019. Clinical efficacy was immediate. Chronic diarrhea disappeared within a few days. Clinical hypercorticism quickly disappeared, with quick improvements in muscle and skin conditions and fatigue. Two months after treatment initiation, urinary free cortisol normalized to 42 µg/24 h. Levels of the tumor markers carcinoembryonic antigen (CEA) and calcitonin also greatly decreased from baseline. After 34 months of treatment, selpercatinib elicits sustained clinical, biological and morphological responses. In summary, this case report illustrates the rapid and long-lasting antisecretory effect of selpercatinib associated with tumor control. As Cushing’s syndrome associated with medullary thyroid cancer is associated with poor prognosis, this case report is very encouraging. In addition, this suggests the potential benefit of molecular testing in all cases of medullary thyroid cancer. Bioscientifica Ltd 2022-09-28 /pmc/articles/PMC9578062/ /pubmed/36069795 http://dx.doi.org/10.1530/ETJ-22-0032 Text en © The authors https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Report
Sitbon, Marine
Chou, Porhuoy
Bengaly, Seydou
Poirot, Brigitte
Laloi-Michelin, Marie
Deville, Laure
Pachev, Atanas
Kowo-Bille, Ahouefa
Dumont, Clement
Chougnet, Cécile N
Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title_full Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title_fullStr Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title_full_unstemmed Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title_short Rapid and long-lasting response to selpercatinib of paraneoplastic Cushing’s syndrome in medullary thyroid carcinoma
title_sort rapid and long-lasting response to selpercatinib of paraneoplastic cushing’s syndrome in medullary thyroid carcinoma
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578062/
https://www.ncbi.nlm.nih.gov/pubmed/36069795
http://dx.doi.org/10.1530/ETJ-22-0032
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