{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T09:34:50Z","timestamp":1793266490305,"version":"4.5.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Selpercatinib is approved for\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      -mutated medullary thyroid carcinoma (MTC); its activity in tumors without detectable\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      alterations is uncertain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Findings:<\/jats:title>\n                    <jats:p>A 50-year-old woman developed rapidly progressive MTC (Ki-67 = 30%) with extensive liver and bone metastases. Because of severe symptomatic progression, selpercatinib was started urgently, off-label, before molecular testing results were available. She had rapid clinical improvement, marked calcitonin and CEA decline, and a remarkable and durable radiographic partial response until the last follow-up (29 months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>\n                      Repeated germline and tumor testing [\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      Sanger sequencing, germline whole-exome sequencing, tumor DNA\/RNA panel testing,\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      Multiplex Ligation-Dependent Probe Amplification (MLPA), tumor whole-genome sequencing] identified no pathogenic or actionable\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      variant, indel, copy-number alteration, or fusion. The only somatic alterations found were\n                      <jats:italic toggle=\"yes\">HRAS<\/jats:italic>\n                      p.G13S and truncating\n                      <jats:italic toggle=\"yes\">NF1<\/jats:italic>\n                      p.R2450*.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      This remarkable response to selpercatinib in apparently\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      -negative MTC is hypothesis generating and requires confirmation.\n                      <jats:italic toggle=\"yes\">HRAS<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">NF1<\/jats:italic>\n                      co-alteration supports RAS\/MAPK activation but does not explain sensitivity to selective\n                      <jats:italic toggle=\"yes\">RET<\/jats:italic>\n                      inhibition.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256261493665","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:33:53Z","timestamp":1790847233000},"page":"1275-1280","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exceptional and Durable Response to Selpercatinib in a Patient with Apparently\n                    <i>RET<\/i>\n                    -Negative,\n                    <i>HRAS<\/i>\n                    -, and\n                    <i>NF1<\/i>\n                    -Mutated Metastatic Medullary Thyroid Carcinoma"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4294-3624","authenticated-orcid":false,"given":"Ali S.","family":"Alzahrani","sequence":"first","affiliation":[{"name":"Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."},{"name":"Molecular Endocrinology Section, Research and Innovation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allianah","family":"Benito","sequence":"additional","affiliation":[{"name":"Molecular Endocrinology Section, Research and Innovation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balgees","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Molecular Endocrinology Section, Research and Innovation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwag","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hindi Nasser","family":"Al-Hindi","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Altuwaijri","sequence":"additional","affiliation":[{"name":"Genomic Medicine Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wedad","family":"Albalawi","sequence":"additional","affiliation":[{"name":"Genomic Medicine Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljoharah","family":"AlSaigh","sequence":"additional","affiliation":[{"name":"Genomic Medicine Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed H.","family":"Al-Hamed","sequence":"additional","affiliation":[{"name":"Genomic Medicine Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi 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