Clinical Scorecard: Case Study: Hyperprogressive Disease Induced by Zoledronic Acid in a Patient with RET-Driven Neuroendocrine Carcinoma Treated with Selpercatinib

At a Glance

Key Highlights

• Patient achieved partial remission with Selpercatinib and denosumab.
• Switch to zoledronic acid led to rapid deterioration and hyperprogressive disease.
• Significant increase in serum NSE levels and radiological progression observed after zoledronic acid treatment.
• Patient's overall survival was 8 months post-diagnosis.

Guideline-Based Recommendations

Diagnosis

• RET mutation testing is recommended for patients with RET-driven malignancies.

Management

• Selpercatinib is indicated for patients with RET mutations, showing efficacy in neuroendocrine carcinoma.

Monitoring & Follow-up

• Close monitoring is required when switching bone-modifying agents during RET inhibitor therapy.

Risks

• Potential for hyperprogressive disease with zoledronic acid in patients receiving RET inhibitors.

Patient & Prescribing Data

59-year-old female with neuroendocrine carcinoma and RET p.V804M mutation.

Initial treatment with Selpercatinib and denosumab was effective; however, switching to zoledronic acid resulted in rapid disease progression.

Clinical Best Practices

• Consider financial implications when prescribing bone-modifying agents.
• Evaluate the risk of hyperprogressive disease when changing treatment regimens.

Related Resources & Content

• NCCN Guidelines
• LIBRETTO-001 Study