Hallmarks of RET and Co-occuring Genomic Alterations in -aberrant Cancers.

Activating receptor-tyrosine kinase rearranged during transfection mutations and fusions are potent drivers of oncogenesis. The recent FDA approvals of highly potent and selective inhibitors, selpercatinib and pralsetinib, has altered the therapeutic management of aberrant tumors. There is ample evidence of the role of RET signaling in certain cancers. RET aberrations as fusions or mutations occur in multiple cancers, however, there is considerable phenotypic diversity. There is emerging data on the lack of responsiveness of immunotherapy in RET-altered cancers. Herein, we review the registrational data from the selective RET-inhibitor trials, and comprehensively explore alterations in pan-cancer adult malignancies and their co-alterations. These co-occuring alterations may define the future of RET inhibition from specific selective targeting to customized combination therapies as data are rapidly emerging on both on-target and off-target acquired resistance mechanisms. Fascinatingly, oncogenic fusions have been reported to mediate resistance to EGFR inhibition and KRAS inhibition.