Lenvatinib treatment for thyroid cancer in COVID era: safety in a patient with lung metastases and SARS-CoV-2 infection

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, clinicians are required to manage patient care for pre-existing conditions. Currently, there are no clear indications regarding the management of lenvatinib-treated patients for radioiodine-refractory thyroid cancer and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 74-year-old male patient was treated with lenvatinib since March 2019, with disease recurrence in the thyroid bed and bilateral multiple lung metastases. The patient partially responded to treatment, with reduction in lung metastases. In September 2019, the patient tested positive for SARS-CoV-2 and isolated at home. Initially asymptomatic, the patient developed mild symptoms. Lenvatinib treatment continued with daily monitoring of vital signs. After telemedicine consultation of patient’s clinical condition, severity of symptoms was low. He tested negative for SARS-CoV-2 21 days after testing positive. The patient received the full course of lenvatinib treatment. This is the first reported case of a lenvatinib-treated patient who developed COVID-19 and could continue treatment. Despite concerns over COVID-19, clinicians should not overlook treatment of pre-existing diseases or discontinue treatment, particularly for cancer. Clinicians should evaluate a patient’s history and clinical presentation, monitoring the patient to reduce the development of complications in high-risk settings, avoiding treatment discontinuation.

Thyroid Cancer and COVID-19: Prospects for Therapeutic Approaches and Drug Development

“…Therefore, sorafenib should be discontinued during chloroquine/hydroxychloroquine treatment. If symptoms such as hypokalemia and fever occur, MKIs should be stopped immediately and a cardiology consultation should be conducted ( 77 ).…”

“…However, it did not progress to anosmia or fever; the patient continued lenvatinib and underwent daily monitoring of vital signs. Twenty-one days later, SARS-CoV-2 test results were negative, and no additional adverse events occurred ( 77 ). These findings suggest that continued lenvatinib treatment is safe during the COVID-19 pandemic, but there remains a need to monitor the safety profile and associated complications of continued cancer treatment in COVID-19 patients through larger studies and longer follow-up periods.…”