Long-term efficacy of lenvatinib for recurrent papillary thyroid carcinoma after multimodal treatment and management of complications: a case report

Abstract

BackgroundThe 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 presentationHere 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.ConclusionsEven 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.

Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report

“…After the approval of lenvatinib, several studies have shown the efficacy of lenvatinib for advanced HCC in the clinical setting 14 , 15 ) . However, several fatal adverse events, including fistula formation, have been reported during the administration of mTKIs (e.g., sorafenib 16 ) , regorafenib 17 ) , and lenvatinib 18 , 19 , 20 ) ) in other cancers. In HCC treatment, there are only a few reports on fistula formation with the use of sorafenib 7 , 21 ) , and there are no reports on fistula formation during lenvatinib administration in patients with HCC.…”

A retrospective study of reducing unnecessary thyroid biopsy for American College of Radiology Thyroid Imaging Reporting and Data Systems 4 assessment through applying shear wave elastography

“…T hyroid nodules are common findings in the general population and have increased in recent years (1)(2)(3). Most thyroid nodules are actually asymptomatic and benign, and only about 5% of thyroid nodules are malignant (4)(5)(6)(7)(8). Ultrasound is the most accurate way to image thyroid nodules because malignant ultrasound features are associated with a higher malignancy risk (9).…”

Embolization of Iliac Metastasis During Lenvatinib Treatment in Patient with Advanced HüRthle Cell Thyroid Carcinoma

“…By contrast, patients developing recurrent or metastatic RAI refractory disease have a 10-year survival rate of only 15-20% [1,2]. Before the advent of tyrosine kinase inhibitors (TKIs), external beam radiotherapy [3,4] and volume reduction surgery were the only available remedies for RAI refractory DTC, while chemotherapy was mostly ineffective [4]. In 2014, sorafenib has been the first available multitargeted TKI [5], followed by lenvatinib, which was approved in 2015, concurring to the results of the Phase III SELECT study [6].…”

“…Among other TKIs, lenvatinib inhibits FGFR1-4, therefore, it offers a potential chance to hamper the mechanism of resistance to the VEGF/VEGFR inhibitors. Besides, lenvatinib has a direct antioncogenic effect as it inhibits RET, thereby controlling tumor cell proliferation and blocking FGFR, and therefore modulating the tumor microenvironment [4,7,8].…”

“…The therapeutic use of lenvatinib is reserved to RAI-resistant metastatic carcinoma, with strict application rules in dosage and timing of use, due to various potential severe adverse events (AEs) that may lead to dose reduction up to therapy interruption [4,9]. Common AEs of lenvatinib include arterial hypertension, fatigue, proteinuria, nausea, decreased weight and abdominal pain, which may decrease the quality of life of patients and influence their acceptance of treatment [10][11][12].…”