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Vandetanib was the first drug approved for medullary thyroid cancer (2011), now largely replaced by RET-selective selpercatinib.
Vandetanib is a multi-kinase inhibitor of RET, VEGFR2 and EGFR, given at 300 mg once daily. It was the first drug approved for medullary thyroid cancer (April 2011), for symptomatic or progressive disease, after the ZETA trial showed a PFS hazard ratio of 0.46 versus placebo. Approval came with a REMS programme because QT prolongation requires ECG and electrolyte monitoring. LIBRETTO-531 then showed the RET-selective selpercatinib was superior first line to vandetanib or cabozantinib (PFS HR 0.28, 12-month PFS 86.8% versus 65.7%) with fewer grade 3 or higher adverse events (52.8% versus 76.4%), so vandetanib is now largely replaced. Its remaining role is in patients who cannot access or tolerate selective RET inhibitors. For a newcomer, it is the original medullary thyroid cancer pill, superseded by a drug built specifically for RET.
Multikinase inhibitor of RET, VEGFR2, and EGFR. Connects to RET, VEGF / VEGFR and EGFR.
1.Blocks RET kinase, the driver in hereditary and most sporadic MTC
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2022/022405s015lbl.pdf. Doses are for orientation; the current label governs.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA550. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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First approval for medullary thyroid cancer
| Region | Year | Indication |
|---|---|---|
| US | 2011 | Symptomatic or progressive medullary thyroid cancer |
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Query for this drug: (TITLE:"Vandetanib" OR ABSTRACT:"Vandetanib" OR TITLE:"Caprelsa" OR ABSTRACT:"Caprelsa") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Vandetanib, not a curated reading list.
Shares ZETA: vandetanib in locally advanced or metastatic medullary thyroid cancer, ZETA, Medullary thyroid cancer, Thyroid cancer.
Shares LIBRETTO-531, RET, Thyroid cancer, Small-molecule kinase inhibitors.
Shares LIBRETTO-531, Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up, Thyroid cancer (KEGG map).
Shares Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Thyroglobulin, calcitonin and CEA in thyroid cancer follow-up, Thyroid cancer.
Shares Thyroid cancer (KEGG map), Medullary thyroid cancer, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), RET.
Shares Medullary thyroid cancer, Thyroid cancer, Small-molecule kinase inhibitors.
Shares LIBRETTO-531, Medullary thyroid cancer.
Shares RET, VEGF / VEGFR, Thyroid cancer, Small-molecule kinase inhibitors.