Partial response to sorafenib treatment associated with transient grade 3 thrombocytopenia in a patient with locally advanced thyroid cancer

Abstract

SUMMARYAdvanced radioactive refractory and progressive or symptomatic differentiated thyroid carcinoma (DTC) is a rare condition. Sorafenib was recently approved for the treatment of these patients. We present the case of a 67 year old woman diagnosed with DTC who underwent a total thyroidectomy with central, lateral-compartment neck dissection and shaving of the trachea and esophagus due to tumor infiltration. A local recurrence was detected 14 months later requiring, additionally, two tracheal rings resection. The patient received a cumulative 131 I dose of 650 mCi and developed dysphagia and dyspnea 63 months after initial surgery. A 18 FGD-PET/CT showed progression of the local mass associated to hypermetabolic pulmonary nodules. Sorafenib 800 mg/day was then prescribed. A dose reduction to 400 mg/day was necessary due to grade 3 thrombocytopenia that appeared four months after drug prescription. Platelet count went to normal after this dose reduction. Five months after initiation of sorafenib, a partial response of the local mass with significant intra-tumoral necrosis was observed. We conclude that sorafenib is a valid option for locally advanced DTC and that the platelet count should be evaluated regularly because it seems that thrombocytopenia might be more frequently observed in DTC than in other types of tumors. Arch Endocrinol Metab. 2015;59(4):347-50

Effect of Sorafenib on Liver Biochemistry Prior to Vitamin B17 Coadministration in Ehrlich Ascites Carcinoma Mice Model: Preliminary Phase Study

“…SOR administration slightly lessen the Hb and RBCs count of tumor-bearing animals. SOR might has a partial response to the synthesis of hemoglobin or prevented hemolysis in specific cases [31]. Our results thus suggested that the SOR is involved in low grade of anemia and RBCs count.…”

Selective use of sorafenib in the treatment of thyroid cancer

“… 95 Alterations in blood cell count were described in Phase II and III clinical trials: anemia (range 25%–38%), 59 , 63 , 64 thrombocytopenia (range 10%–29%), 59 , 63 , 64 lymphocytopenia (14%), and neutropenia (33%). 64 In all cases, these adverse events were grade 1 or 2 with the exception of one case of febrile neutropenia 65 and one case of grade ≥3 thrombocytopenia reported in the study of Lam et al 64 Pitoia et al 96 have recently published one clinical case of grade 3 thrombocytopenia, which was solved by dose reduction of sorafenib. Other alterations in serum chemistry such as hypocalcemia (range 18.8%–57%), 47 , 59 , 63 , 64 which is more frequent and severe in patients with thyroid…”

The evolving field of thyroid cancer: refinement of old and creation of new paradigms

“…report a patient with progressive iodine-refractory DTC in whom treatment with sorafenib provided partial tumor response but was associated with significant thrombocytopenia, requiring dose adjustment (8). Adverse events associated with kinase inhibitors are frequent and this report underlies the importance of being aware that unexpected side effects, such as thrombocytopenia, can also be observed.…”