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Medullary Thyroid Carcinoma

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12 Treatment Î In patients with significant tumor burden and symptomatic or progressive metastatic disease according to Response Evaluation Criteria in Solid Tumors (RECIST), treatment with tyrosine kinase inhibitors (TKIs), targeting both RET and vascular endothelial growth factor receptor, should be considered as systemic therapy. (A) Note: The TKIs vandetanib or cabozantinib can be used as single agent first line systemic therapy in patients with advanced progressive MTC. Î Patients with advanced MTC and diarrhea should be treated initially with anti-motility agents. Alternative therapies include somatostatin analogues and local therapies such as surgery or chemoembolization. (C) Î Patients with metastatic MTC and Cushing's syndrome due to ectopic production of adrenocorticotropic hormone or corticotropin-releasing hormone are often markedly debilitated and should be treated despite their poor prognosis. (C) Note: Treatment options include medical therapy with ketoconazole, mifepristone, aminoglutethimide, metyrapone, or mitotane. In cases refractory to medical treatment bilateral adrenalectomy is an option.

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