Reference Detail

Ref Type

Journal Article

PMID

(35616103)

Authors

Elisei R, Ciampi R, Matrone A, Prete A, Gambale C, Ramone T, Simeakis G, Materazzi G, Torregrossa L, Ugolini C, Romei C

Title

Somatic RET Indels in Sporadic Medullary Thyroid Cancer: Prevalence and Response to Selpercatinib.

Journal	Vol	Issue	Date	Pages	Journal Short Title
The Journal of clinical endocrinology and metabolism	107	8	2022 07 14	2195-2202	J Clin Endocrinol Metab

URL

Abstract Text

Although the majority of RET alterations are single nucleotide variants (SNV), small deletions and/or insertions have been reported at variable prevalence. No information about the efficacy of RET-specific inhibitors in patients harboring RET indels has been provided.We present an update on the prevalence of RET indels in medullary thyroid cancer (MTC) and describe the efficacy of selpercatinib in patients with advanced MTC with RET indels.The MTC tissues of 287 patients were analyzed using an Ion S5 targeted sequencing. The functional role of the reported indels have been evaluated by MutationTaster. Clinical and pathological data of MTC patients harboring a RET indel were collected and analyzed. Two patients with a RET indel were treated with selpercatinib.Among 178 RET-positive cases, 147 (82.6%) harbored a SNV and 31 (17.4%) a RET in-frame indel. Nine indels were not previously reported and were found to be disease causing by MutationTaster. Patients harboring an indel were found to have an aggressive disease and 2 of them were treated with selpercatinib, experiencing a good response to the treatment.These data show that RET indels are not infrequent and correlate with an aggressive disease. Two RET indel-positive patients showed a partial response to the treatment with a highly selective RET inhibitor; thus, these RET indels can be considered actionable mutations. In order to not miss these alterations, the analysis of the full gene is recommended.

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Molecular Profile	Treatment Approach

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description
RET	C634_A640dup	duplication	unknown	RET C634_A640dup indicates the insertion of 7 duplicate amino acids, cysteine (C)-634 through alanine (A)-640, in the helical domain of the Ret protein (UniProt.org). C634_A640dup has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	D631_L633delinsS	indel	unknown	RET D631_L633delinsS results in a deletion of three amino acids in the extracellular domain of the Ret protein from amino acids 631 to 633, combined with the insertion of one serine (S) at the same site (UniProt.org). D631_L633delinsS has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	E632_A639delinsHR	indel	unknown	RET E632_A639delinsHR results in a deletion of eight amino acids in the extracellular domain of the Ret protein from amino acids 632 to 639, combined with the insertion of a histidine (H) and an arginine (R) at the same site (UniProt.org). E632_A639delinsHR has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	E632_C634del	deletion	unknown	RET E632_C634del results in the deletion of three amino acids in the extracellular domain of the Ret protein from amino acids 632 to 634 (UniProt.org). E632_C634del has been identified in the scientific literature (PMID: 35616103, PMID: 31605946), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	G592_G607del	deletion	unknown	RET G592_G607del results in the deletion of 16 amino acids in the extracellular domain of the Ret protein from amino acids 592 to 607 (UniProt.org). G592_G607del has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	I590_G607del	deletion	unknown	RET I590_G607del results in the deletion of 18 amino acids in the extracellular domain of the Ret protein from amino acids 590 to 607 (UniProt.org). I590_G607del has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	L629_D631delinsH	indel	unknown	RET L629_D631delinsH results in a deletion of three amino acids in the extracellular domain of the Ret protein from amino acids 629 to 631, combined with the insertion of one histidine (H) at the same site (UniProt.org). L629_D631delinsH has been identified in the scientific literature (PMID: 35616103, PMID: 31605946), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	S649_V650insLLLL	insertion	unknown	RET S649_V650insLLLL results in the insertion of four amino acids in the helical domain of the Ret protein between amino acids 649 and 650 (UniProt.org).). S649_V650insLLLL has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).
RET	V899_E902del	deletion	unknown	RET V899_E902del results in the deletion of four amino acids in the protein kinase domain of the Ret protein from amino acids 899 to 902 (UniProt.org). V899_E902del has been identified in the scientific literature (PMID: 35616103), but has not been biochemically characterized and therefore, its effect on Ret protein function is unknown (PubMed, Apr 2024).

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
RET E632_L633del	thyroid gland medullary carcinoma	conflicting	Selpercatinib	Case Reports/Case Series	Actionable	In a Phase I trial, Retevmo (selpercatinib) resulted in a partial response in the target lesions and stable disease in the non-target lesions in a patient with sporadic medullary thyroid cancer harboring RET E632_L633del, and treatment continued for at least 17 months (PMID: 35616103; NCT03906331).	35616103
RET D631_L633delinsS	thyroid gland medullary carcinoma	predicted - sensitive	Selpercatinib	Case Reports/Case Series	Actionable	In a Phase I trial, Retevmo (selpercatinib) resulted in stable disease in the target lesions and a partial response in the non-target lesions in a patient with sporadic medullary thyroid cancer harboring RET D631_L633delinsS (PMID: 35616103; NCT03906331).	35616103