Carcinoembryonic Antigen (CEA) as a Therapeutic Target in Medullary Thyroid Cancer (MTC)
6 affiliations
- 1Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
- 2Division of Head & Neck Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
- 3Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA
- 4Department of Immuno-Oncology, Beckman Research Institute at City of Hope National Medical Center, Duarte, CA 91010, USA
- 5Department of Immunology & Theranostics, Beckman Research Institute at City of Hope National Medical Center, Duarte, CA 91010, USA
- 6Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
Abstract
Background/Objectives: Medullary thyroid cancer (MTC) is a rare but aggressive neuroendocrine malignancy arising from parafollicular C cells. Despite its low incidence, MTC has historically been estimated to account for 13.4% of thyroid cancer-related deaths. Survival outcomes remain limited in advanced disease, with a historical cohort reporting a 10-year survival of 21% for stage IV MTC, supporting the need for novel therapeutic approaches. Carcinoembryonic antigen (CEA), a fetal glycoprotein minimally expressed in normal adult tissues, is elevated in various malignancies and plays an established role in carcinogenesis, metastasis, and therapy resistance. In MTC, CEA is produced by neoplastic C cells alongside calcitonin, and both serum and tumor-associated CEA levels are markedly elevated relative to healthy tissue. More than half of MTC patients demonstrate elevated CEA, and intense CEA immunohistochemical staining correlates with aggressive, disseminated disease, highlighting its potential utility as both a biomarker and investigational therapeutic target in the disease. For MTC, surgery is the mainstay for locoregional disease with the intent for complete surgical resection when possible. Systemic therapy is generally reserved for structurally progressive, unresectable, symptomatic, or threatening advanced disease, with selective RET inhibitors used in RET-mutant disease and multi-kinase TKIs as additional treatment options. Although TKIs have improved progression-free survival, treatment can be limited by toxicities and the development of resistance over time. These limitations underscore the need for novel therapeutic strategies that can achieve more durable disease control and improve overall survival. Given its strong association with tumor burden, disease progression, and aggressive pathology, CEA represents a promising investigational target for therapeutic exploration in MTC. Methods: A narrative literature review was performed to evaluate carcinoembryonic antigen (CEA) as a therapeutic target and biomarker in medullary thyroid cancer (MTC). Searches were conducted in 2025 and 2026 using PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov. Conclusions: The current literature supports further investigation of CEA targeting as a therapeutic strategy in MTC. However, CEA is not yet a clinically validated therapeutic target and clinical trial data remain limited.
Related
- Index-window C-reactive protein and carcinoembryonic antigen and five-year all-cause mortality in Hispanic/Latino and non-Hispanic White patients with colorectal cancer: a retrospective biomarker cohort study.
- Baseline serum carcinoembryonic antigen (CEA) is an independent prognostic biomarker for metastatic castration-resistant prostate cancer (mCRPC) patients receiving 177Lu-PSMA therapy
- Diagnostic Challenge in Cytology: Fibrosing Thyroiditis Mimicking Medullary Thyroid Carcinoma.
- Synchronous medullary and papillary thyroid carcinoma with mixed-component lateral cervical lymph node metastases: a case report
- Commentary: Selpercatinib versus multi-kinase inhibitors for advanced medullary thyroid cancer: a network meta-analysis of RET-targeted therapies.
BibTeX
@article{bowyer2026carcinoembryonic,
title = {{Carcinoembryonic Antigen (CEA) as a Therapeutic Target in Medullary Thyroid Cancer (MTC)}},
author = {Kasey R. Bowyer and Marice B. Alcantara and Fang Fan and Colt A. Egelston and Paul J. Yazaki and Jeffrey Wong and Thinzar Lwin and Jack Shively and Maciej Kujawski and Krupal B. Patel},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18213432},
url = {https://www.mdpi.com/2072-6694/18/21/3432},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Carcinoembryonic Antigen (CEA) as a Therapeutic Target in Medullary Thyroid Cancer (MTC)
AU - Kasey R. Bowyer
AU - Marice B. Alcantara
AU - Fang Fan
AU - Colt A. Egelston
AU - Paul J. Yazaki
AU - Jeffrey Wong
AU - Thinzar Lwin
AU - Jack Shively
AU - Maciej Kujawski
AU - Krupal B. Patel
PY - 2026
DA - 2026/10/23
JO - Cancers
DO - 10.3390/cancers18213432
UR - https://www.mdpi.com/2072-6694/18/21/3432
AB - Background/Objectives: Medullary thyroid cancer (MTC) is a rare but aggressive neuroendocrine malignancy arising from parafollicular C cells. Despite its low incidence, MTC has historically been estimated to account for 13.4% of thyroid cancer-related deaths. Survival outcomes remain limited in advanced disease, with a historical cohort reporting a 10-year survival of 21% for stage IV MTC, supporting the need for novel therapeutic approaches. Carcinoembryonic antigen (CEA), a fetal glycoprotein minimally expressed in normal adult tissues, is elevated in various malignancies and plays an established role in carcinogenesis, metastasis, and therapy resistance. In MTC, CEA is produced by neoplastic C cells alongside calcitonin, and both serum and tumor-associated CEA levels are markedly elevated relative to healthy tissue. More than half of MTC patients demonstrate elevated CEA, and intense CEA immunohistochemical staining correlates with aggressive, disseminated disease, highlighting its potential utility as both a biomarker and investigational therapeutic target in the disease. For MTC, surgery is the mainstay for locoregional disease with the intent for complete surgical resection when possible. Systemic therapy is generally reserved for structurally progressive, unresectable, symptomatic, or threatening advanced disease, with selective RET inhibitors used in RET-mutant disease and multi-kinase TKIs as additional treatment options. Although TKIs have improved progression-free survival, treatment can be limited by toxicities and the development of resistance over time. These limitations underscore the need for novel therapeutic strategies that can achieve more durable disease control and improve overall survival. Given its strong association with tumor burden, disease progression, and aggressive pathology, CEA represents a promising investigational target for therapeutic exploration in MTC. Methods: A narrative literature review was performed to evaluate carcinoembryonic antigen (CEA) as a therapeutic target and biomarker in medullary thyroid cancer (MTC). Searches were conducted in 2025 and 2026 using PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov. Conclusions: The current literature supports further investigation of CEA targeting as a therapeutic strategy in MTC. However, CEA is not yet a clinically validated therapeutic target and clinical trial data remain limited.
SN - 2072-6694
ER -