Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus

As new precision oncology therapies become available in the thyroid cancer (TC) treatment landscape, appropriate and timely biomarker testing is crucial for treatment selection and requires a multidisciplinary approach. Recently published European guidelines on advanced/metastatic TC management incl...

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Main Authors: Aleš Ryška, Jaume Capdevila, Matthias S Dettmer, Rossella Elisei, Dagmar Führer, Julien Hadoux, Barbara Jarząb, Laura D Locati, Kate Newbold, Giovanni Tallini, Silvia Uccella, Lori Wirth, Ravinder Singh, Iris M Simon, Pilar Camacho, Laura Fugazzola
Format: Article
Language:English
Published: Bioscientifica 2025-07-01
Series:European Thyroid Journal
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Online Access:https://etj.bioscientifica.com/view/journals/etj/14/4/ETJ-25-0024.xml
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author Aleš Ryška
Jaume Capdevila
Matthias S Dettmer
Rossella Elisei
Dagmar Führer
Julien Hadoux
Barbara Jarząb
Laura D Locati
Kate Newbold
Giovanni Tallini
Silvia Uccella
Lori Wirth
Ravinder Singh
Iris M Simon
Pilar Camacho
Laura Fugazzola
author_facet Aleš Ryška
Jaume Capdevila
Matthias S Dettmer
Rossella Elisei
Dagmar Führer
Julien Hadoux
Barbara Jarząb
Laura D Locati
Kate Newbold
Giovanni Tallini
Silvia Uccella
Lori Wirth
Ravinder Singh
Iris M Simon
Pilar Camacho
Laura Fugazzola
author_sort Aleš Ryška
collection DOAJ
description As new precision oncology therapies become available in the thyroid cancer (TC) treatment landscape, appropriate and timely biomarker testing is crucial for treatment selection and requires a multidisciplinary approach. Recently published European guidelines on advanced/metastatic TC management include a special focus on biomarker testing. However, to date, there remains a need for comprehensive European guidance for standardized molecular testing strategies in TC that encompass a broad set of targetable or potentially targetable alterations, timing of testing, and patients to be tested. This expert opinion article outlines consensus testing algorithms for differentiated TC, medullary TC, and anaplastic TC from a team of endocrinologists, oncologists, molecular biologists, and pathologists to provide standardized recommendations for physicians involved in treating patients with advanced TC. In the differentiated TC algorithm, patients recommended for comprehensive testing by DNA and RNA next-generation sequencing (NGS) include those whose disease has progressed on or is resistant to radioactive iodine treatment. The medullary TC algorithm recommends RET germline testing for all patients at diagnosis. For patients exhibiting high-risk clinical or pathological features and those whose disease progresses, somatic RET testing with NGS should be discussed and conducted before considering systemic treatment. As anaplastic TC is a highly aggressive disease, molecular reflex testing for BRAF mutations is recommended for all patients at diagnosis, followed by DNA and RNA NGS for those who test BRAF negative. The article also provides consensus recommendations on the use of tumor tissue for testing and on centralization of molecular testing involving multidisciplinary tumor boards.
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spelling doaj-art-17efa3dec92f412096e530900aaf00bb2025-08-20T03:27:19ZengBioscientificaEuropean Thyroid Journal2235-08022025-07-0114410.1530/ETJ-25-00241Molecular predictive biomarker testing in advanced thyroid cancer – a European consensusAleš Ryška0Jaume Capdevila1Matthias S Dettmer2Rossella Elisei3Dagmar Führer4Julien Hadoux5Barbara Jarząb6Laura D Locati7Kate Newbold8Giovanni Tallini9Silvia Uccella10Lori Wirth11Ravinder Singh12Iris M Simon13Pilar Camacho14Laura Fugazzola15The Fingerland Department of Pathology, Charles University, Faculty of Medicine, Hradec Kralove, CzechiaVall d’Hebron University Hospital, Barcelona, SpainKlinikum Stuttgart, Institute of Pathology, Stuttgart, Baden-Württemberg, GermanyEndocrine Unit, University Hospital of Pisa, Pisa, ItalyDepartment of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Centre at West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, GermanyService d’oncologie endocrinienne, département d’imagerie & ENDOCAN-TUTHYREF Network, Gustave Roussy, Villejuif, FranceNarodowy Instytut Onkologii im. M. Curie Sklodowskiej, Gliwice Branch, Gliwice, PolandDepartment of Internal Medicine and Therapeutics, University of Pavia, Pavia, ItalyRoyal Marsden NHS Foundation Trust, Thyroid Unit, London, UKUniversity of Bologna, Department of Medical and Surgical Sciences (DIMEC) Bologna, Emilia-Romagna, ItalyHumanitas University, Milan, Italy and IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USAEli Lilly and Company, Indianapolis, Indiana, USAEli Lilly and Company, Indianapolis, Indiana, USAEli Lilly and Company, Indianapolis, Indiana, USADepartment of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS and Department of Pathophysiology and Transplantation, University of Milan, Milan, ItalyAs new precision oncology therapies become available in the thyroid cancer (TC) treatment landscape, appropriate and timely biomarker testing is crucial for treatment selection and requires a multidisciplinary approach. Recently published European guidelines on advanced/metastatic TC management include a special focus on biomarker testing. However, to date, there remains a need for comprehensive European guidance for standardized molecular testing strategies in TC that encompass a broad set of targetable or potentially targetable alterations, timing of testing, and patients to be tested. This expert opinion article outlines consensus testing algorithms for differentiated TC, medullary TC, and anaplastic TC from a team of endocrinologists, oncologists, molecular biologists, and pathologists to provide standardized recommendations for physicians involved in treating patients with advanced TC. In the differentiated TC algorithm, patients recommended for comprehensive testing by DNA and RNA next-generation sequencing (NGS) include those whose disease has progressed on or is resistant to radioactive iodine treatment. The medullary TC algorithm recommends RET germline testing for all patients at diagnosis. For patients exhibiting high-risk clinical or pathological features and those whose disease progresses, somatic RET testing with NGS should be discussed and conducted before considering systemic treatment. As anaplastic TC is a highly aggressive disease, molecular reflex testing for BRAF mutations is recommended for all patients at diagnosis, followed by DNA and RNA NGS for those who test BRAF negative. The article also provides consensus recommendations on the use of tumor tissue for testing and on centralization of molecular testing involving multidisciplinary tumor boards.https://etj.bioscientifica.com/view/journals/etj/14/4/ETJ-25-0024.xmlbiomarkersconsensusmolecular testingthyroid cancermultidisciplinary
spellingShingle Aleš Ryška
Jaume Capdevila
Matthias S Dettmer
Rossella Elisei
Dagmar Führer
Julien Hadoux
Barbara Jarząb
Laura D Locati
Kate Newbold
Giovanni Tallini
Silvia Uccella
Lori Wirth
Ravinder Singh
Iris M Simon
Pilar Camacho
Laura Fugazzola
Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
European Thyroid Journal
biomarkers
consensus
molecular testing
thyroid cancer
multidisciplinary
title Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
title_full Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
title_fullStr Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
title_full_unstemmed Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
title_short Molecular predictive biomarker testing in advanced thyroid cancer – a European consensus
title_sort molecular predictive biomarker testing in advanced thyroid cancer a european consensus
topic biomarkers
consensus
molecular testing
thyroid cancer
multidisciplinary
url https://etj.bioscientifica.com/view/journals/etj/14/4/ETJ-25-0024.xml
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