Aerodigestive Fistula Formation as a Rare Side Effect of Antiangiogenic Tyrosine Kinase Inhibitor Therapy for Thyroid Cancer

Blevins, Dean; Dadu, Ramona; Hu, Mimi I.; Baik, Christina S.; Balachandran, Diwakar D.; Ross, William; Gunn, G. Brandon; Cabanillas, Maria E.

doi:10.1089/thy.2012.0598

Cited by 90 publications

(69 citation statements)

References 20 publications

(12 reference statements)

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“…Page 15 of 41 (Blevins, et al 2014;Lamartina, et al 2016). External beam radiation therapy on metastases may be 334 performed during TKI treatment, and there is no evidence that irradiation of brain metastases before the 335 initiation of TKI treatment may decrease the risk of bleeding (Tallet, et al 2017).…”

Section: Initiation Of Systemic Treatment 323mentioning

confidence: 99%

“…Lenvatinib that 348 appeared to be the most effective drug is thus used as first line treatment in the absence of 349 contraindication. Treatment should be initiated when tumor burden is still limited, preferably before the 350 appearance of symptoms and at a stage when large vessels and the tracheoesophageal tracts are not 351 involved by the disease (Blevins et al 2014;Lamartina et al 2016). Trial consideration should be given to all 352 patients, even in countries where a drug is currently approved.…”

Section: Initiation Of Systemic Treatment 323mentioning

confidence: 99%

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Treatment of refractory thyroid cancer

Berdelou¹,

Lamartina²,

Klain³

et al. 2018

Endocrine-Related Cancer

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Distant metastases from thyroid cancer of follicular origin are uncommon. Treatment includes levothyroxine administration, focal treatment modalities with surgery, external radiation therapy and thermal ablation, and radioiodine in patients with uptake of 131 I in their metastases. Two thirds of distant metastases become refractory to radioiodine at some point, and when there is a significant tumor burden and documented progression on imaging, a treatment with a kinase inhibitor may provide benefits.

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Section: Initiation Of Systemic Treatment 323mentioning

confidence: 99%

Section: Initiation Of Systemic Treatment 323mentioning

confidence: 99%

Treatment of refractory thyroid cancer

Berdelou¹,

Lamartina²,

Klain³

et al. 2018

Endocrine-Related Cancer

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“…4) and who later developed TEFs (patients 1 and 2) or laryngeal necrosis (patient 3). Associations between VEGFR MKIs and upper aerodigestive tract complications have been described previously (14,15), and fistula development outside of the gastrointestinal tract occurred in 3.7% of treated patients participating in a phase III trial of cabozantinib for MTC (7). In a study of 43 head and neck cancer patients receiving bevacizumab, 5 developed TEFs (16).…”

Section: Discussionmentioning

confidence: 92%

“…Reviewing prior reports of upper aerodigestive tract complications in patients receiving TKIs, a case series by Blevins et al (14) described 3 patients with metastatic thyroid cancer who developed upper aerodigestive tract fistulas while on VEGFR MKI therapy. In a large retrospective review of 140 thyroid cancer patients treated with VEGFR MKIs (17), 9 patients developed clinically apparent hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

“…Less commonly, TKIs have been linked with the development of gastrointestinal perforations in patients being treated for solid tumors (12,13). Prior reports have also suggested an affiliation between VEGFR MKIs and upper aerodigestive tract fistulas in patients being treated for advanced thyroid cancer and other head and neck cancers (14,15). In a phase III trial of cabozantinib for MTC treatment, 0.9% and 3.7% of treated patients developed gastrointestinal and non-gastrointestinal fistulas, respectively, although the extent to which these nongastrointestinal fistulas involved the upper aerodigestive tract was not stated (7).…”

Section: Introductionmentioning

confidence: 99%

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Development of Upper Aerodigestive Tract Complications in Patients with Stage IV Thyroid Cancer Receiving Tyrosine Kinase Inhibitors

Perdoni

Olcott

Lieb

et al. 2018

AACE Clinical Case Reports

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Objective: Tyrosine kinase inhibitors (TKIs) are a class of systemic chemotherapy used in patients with radioactive iodine-refractory metastatic thyroid cancer. TKIs have been linked with impaired wound healing, but their association with upper aerodigestive tract complications is not well defined. The objective of this case series was to demonstrate that upper aerodigestive tract complications can occur in thyroid cancer patients receiving TKIs.Methods: A retrospective chart review was conducted on 3 cases involving patients with stage IV differentiated or medullary thyroid cancer treated between the years from 2000 to 2015. Each patient received surgical management, external beam radiation therapy, and subsequent TKI therapy and they also developed upper aerodigestive tract complications during their clinical course.Results: Patient 1 received TKIs for radioactive iodine-refractory pulmonary metastases and developed a tracheoesophageal fistula 1 year after initiation of chemotherapy. Patient 2 received TKIs for pulmonary metastases and developed a tracheoesophageal fistula several months after initiation of chemotherapy. Patient 3 was placed on TKIs for progressive metastatic disease 9 years after initial intervention and later developed laryngeal necrosis.Conclusion: Systemic TKIs can offer a clinical benefit in patients with metastatic thyroid cancer. However, clinicians should monitor patients for upper aerodigestive tract fistula formation and tissue necrosis during and after TKI therapy. Although a history of external beam radiation therapy may place patients at increased risk for fistula development, further investigation is needed to determine the relative risk associated with subsequent TKI exposure in these patients. (AACE Clinical Case Rep. 2018;4:e270-e274) Abbreviations: DTC = differentiated thyroid cancer; EBRT = external beam radiation therapy; MKI = multikinase inhibitor; MTC = medullary thyroid cancer; RAI = radioactive iodine; TEF = tracheoesophageal fistula; TKI = tyrosine kinase inhibitor; VEGFR = vascular endothelial growth factor receptor

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Neoadjuvant lenvatinib for inoperable thyroid cancer: A case report and literature review

et al. 2021

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Background: Poorly differentiated thyroid cancer (PDTC) is now classified as a separate thyroid tumor entity. It has male predominance and poor prognosis compared to differentiated TC.Case: We report a case of a patient with PDTC who was previously deemed inoperable. A trial of neoadjuvant lenvatinib therapy was given to the patient after that the tumor become operable and the surgery went successfully.Conclusions: Lenvatinib is a feasible option in patients with inoperable TC and can stabilize the lesion size or even reduce it, leading to a more favorable surgical outcome.

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Aerodigestive Fistula Formation as a Rare Side Effect of Antiangiogenic Tyrosine Kinase Inhibitor Therapy for Thyroid Cancer

Cited by 90 publications

References 20 publications

Treatment of refractory thyroid cancer

Treatment of refractory thyroid cancer

Development of Upper Aerodigestive Tract Complications in Patients with Stage IV Thyroid Cancer Receiving Tyrosine Kinase Inhibitors

Neoadjuvant lenvatinib for inoperable thyroid cancer: A case report and literature review

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