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Masaki C, Sugino K, Akaishi J, Hames KY, Tomoda C, Suzuki A, Matsuzu K, Ohkuwa K, Kitagawa W, Nagahama M, Ito K. Successful dose escalation of lenvatinib for thyroid cancer after disease progression. Endocrine 2022; 78:77-84. [PMID: 35737285 DOI: 10.1007/s12020-022-03117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Lenvatinib is started at a standard dose, continuing with dose reduction and interruption, balancing between efficacy and adverse events (AEs). Because few drugs are available for thyroid cancer, efforts for continuing treatment with one agent, such as "dose escalation (DE)", are made. The dose is increased, aiming to regain the anti-tumor effect after dose reduction. The effects of lenvatinib DE in differentiated thyroid carcinoma (DTC) patients are reported. PATIENTS AND METHODS The efficacy of lenvatinib DE in DTC patients using the serum thyroglobulin (Tg) level and management of AEs was investigated. RESULTS A total of 70 DE episodes in 33 patients were investigated. The median increased dose was 2.0 (1.0-14.0) mg, increased from 8.6 (2-16) mg to 10.1 (6-24) mg. The serum Tg level decreased in 53 DE episodes. Though the serum Tg level in 17 DE episodes was not decreased, the Tg rate of increase was decreased in 7 of these DE episodes using the Tg-doubling rate. Overall, clinical benefit was seen in 60 (86%) DE episodes. AEs that could not be controlled after DEs were seen in only 16% of cases. No intolerable AEs were observed in patients who received more drug holidays at the time of DEs compared to two times before the DEs. CONCLUSION DE may become one of the standard treatment strategies after disease progression if AEs are well managed. Drug holidays may be a key for successfully controlling AEs with DE. DE can be useful for controlling progressive disease with increasing Tg levels.
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Affiliation(s)
- Chie Masaki
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Junko Akaishi
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kiyomi Y Hames
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Chisato Tomoda
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Akifumi Suzuki
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
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Tori M, Shimo T. Long-term efficacy of lenvatinib for recurrent papillary thyroid carcinoma after multimodal treatment and management of complications: a case report. BMC Cancer 2018; 18:698. [PMID: 29954369 PMCID: PMC6022486 DOI: 10.1186/s12885-018-4612-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 06/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background The advent of tyrosine kinase inhibitors (TKIs) has changed the treatment of RAI refractory, unresectable recurrent differentiated thyroid cancer (DTC), which was formerly treated with multidisciplinary remedies. Case presentation Here we describe the case of a 64-year-old woman who underwent total thyroidectomy with tracheal resection and suffered from a recurrent tumor in the neck and multiple lung and bone metastases 3 and 11 months, respectively, after the operation. Multimodal therapies, RI (I-131), EBRT, and taxane-based chemotherapy were ineffective, and sorafenib was started as a TKI. However, because of disease progression, sorafenib was replaced by lenvatinib after 9 months. The effect of lenvatinib has continued for more than 1 year and 9 months, and the patient has well survived. During the treatment period, a tracheal pin-hole fistula suddenly emerged, which was naturally cured by the temporary cessation of lenvatinib. Adverse events such as hypertension, proteinuria, and diabetes as innate complications have been successfully managed until the present according to our institute regulations. Conclusions Even where multimodal treatment was ineffective, lenvatinib was suggested to be an alternative treatment option for RAI refractory recurrent DTC and patient could have a chance to be controlled successfully.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan.
| | - Toshirou Shimo
- Department of Endocrine Surgery, Osaka Police Hospital, Kitayamacho 10-31, Tnnoujiku, Osaka, 543-0035, Japan
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