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Selpercatinib tops cabozantinib and vandetanib for PFS in advanced medullary thyroid cancerSelpercatinib Shows Better Survival for Advanced Medullary Thyroid Cancer

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Key Takeaway
Consider selpercatinib as first-line therapy for advanced medullary thyroid cancer based on superior PFS and ORR vs cabozantinib and vandetanib.

This network meta-analysis compared selpercatinib, cabozantinib, vandetanib, and anlotinib in 1,076 patients with advanced medullary thyroid cancer. The primary outcome was progression-free survival (PFS), with secondary outcomes including objective response rate (ORR) and ≥Grade 3 adverse events.

Selpercatinib demonstrated the most significant PFS benefit, with a hazard ratio of 0.10 (95% CI: 0.05–0.18; P-score = 0.999) compared to cabozantinib (HR = 0.28) and vandetanib (HR = 0.46). For ORR, selpercatinib ranked first (OR = 122.6; 95% CI: 34.5–435.6).

Regarding safety, selpercatinib was associated with hepatotoxicity (OR = 4.20), while anlotinib exhibited the highest toxicity (OR = 12.00). Selpercatinib showed no significant difference in ≥Grade 3 AEs compared to placebo (OR = 1.34) and avoided off-target toxicities typical of MKIs, such as hypertension and diarrhea.

Limitations include heterogeneity of included populations (mixed RET mutation status and therapy lines) and limited generalizability to strictly defined RET-mutant populations. The results support selpercatinib as a recommended first-line option for advanced MTC, though clinical decisions should be individualized.

How this fits prior evidence

This network meta-analysis extends prior coverage of anlotinib-containing regimens (e.g., toripalimab plus anlotinib in ES-SCLC, penpulimab-nab-paclitaxel-anlotinib in porocarcinoma) by directly comparing anlotinib with other TKIs in medullary thyroid cancer. It confirms selpercatinib's superiority over multi-kinase inhibitors, consistent with its RET-targeted mechanism. The finding contrasts with earlier case-level evidence for anlotinib combinations, which lacked comparative data.

Researchers conducted a network meta-analysis to compare different treatments for patients with advanced medullary thyroid cancer. The study looked at 1,076 patients who were treated with drugs including selpercatinib, cabozantinib, vandetanib, and anlotinib. These medications are used to manage the growth of the cancer.

The results showed that selpercatinib provided the most significant benefit for progression-free survival compared to both cabozantinib and vandetanib. It also ranked first in terms of objective response rate. While some drugs in this group, like anlotinib, showed higher toxicity levels, selpercatinib was noted for avoiding certain common side effects like hypertension and diarrhea.

It is important to note that the study included a diverse group of patients with different mutation statuses and treatment histories. Because of this mix, the results might not apply perfectly to every specific type of patient. Doctors should still consider each patient's unique situation before choosing a treatment plan.

What this means for you:
Selpercatinib showed better survival outcomes than other drugs in this study for advanced medullary thyroid cancer.

Common questions

How does selpercatinib compare to other drugs like cabozantinib?

The study found that selpercatinib showed a more significant benefit in progression-free survival compared to both cabozantinib and vandetanib. It also ranked first for the objective response rate among the medications studied.

What are the known side effects of these treatments?

Anlotinib showed the highest toxicity levels in the study. While selpercatinib was associated with some hepatotoxicity, it did not show significant differences in severe adverse events compared to a placebo and avoided common issues like hypertension and diarrhea.

Who is this finding most relevant for?

These findings are relevant for patients with advanced medullary thyroid cancer. However, because the study included a diverse group of patients, your doctor should determine the best treatment based on your specific medical history.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundSeveral RET-targeted agents, including highly selective RET inhibitors (SRIs) and multi-kinase inhibitors (MKIs), have been approved for the treatment of advanced medullary thyroid cancer (MTC). Despite these agents targeting the same pathway, direct comparative data is lacking. This study aims to evaluate the relative efficacy and safety of these agents via network meta-analysis (NMA).MethodsWe systematically searched PubMed, Embase, Cochrane Library, Web of Science, and CNKI (up to March 2026) for RCTs evaluating RET-targeted therapies for advanced MTC. The primary outcome was progression-free survival (PFS); secondary outcomes included objective response rate (ORR) and ≥Grade 3 adverse events (AEs). A frequentist random-effects model was employed, and treatments were ranked using P-scores. The study was registered in PROSPERO (CRD420261342793).ResultsFive RCTs (n = 1,076) were included. Selpercatinib demonstrated the most significant PFS benefit (HR = 0.10, 95% CI: 0.05–0.18; P-score = 0.999), outperforming cabozantinib (HR = 0.28) and vandetanib (HR = 0.46). It also ranked first for ORR (OR = 122.6, 95% CI: 34.5–435.6). Regarding safety, selpercatinib showed no significant difference in ≥Grade 3 AEs compared to placebo (OR = 1.34), whereas anlotinib exhibited the highest toxicity (OR = 12.00). Although selpercatinib was associated with hepatotoxicity (OR = 4.20), it avoided the off-target toxicities typical of MKIs, such as hypertension and diarrhea.ConclusionThis network meta-analysis demonstrates that selpercatinib exhibits superior efficacy (PFS and ORR) and a more favorable safety profile compared to MKIs for advanced MTC. These results support its role as a recommended first-line option for advanced MTC. However, due to the heterogeneity of included populations (mixed RET mutation status and therapy lines), clinicians should interpret these findings with caution regarding the generalizability to strictly defined RET-mutant populations. Clinical decisions should be individualized.Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420261342793, identifier CRD420261342793.
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