Iodine radioactive/lenvatinib
Ineffectiveness and various toxicities: 3 case reportsIn a study of 3 patients with thyroid carcinoma (TC) treated at a centre in Japan, 3 women aged between 58 years and ~64 years were described, who experienced ineffectiveness or developed anaplastic TC transformation, leucocytosis, hypertension (HT), alopecia, arthralgia or stomatitis during treatment with iodine radioactive or lenvatinib for metastatic TC [routes not stated; not all times to reactions onsets, dosages and outcomes stated].Case 1: The 58-year-old woman, who had a history of TC with metastases to the lungs and pelvis, total thyroidectomy (2015), treatment with external beam radiation to the left pelvis, iodine radioactive [radioactive iodine] therapy and denosumab, started receiving lenvatinib 14mg. Lenvatinib was temporarily stopped, and then started at a reduced dose of 10mg after 8 weeks. She experienced adverse events (AE) of hypertension and appetite loss [aetiologies unknown]. Subsequently, the pulmonary metastasis slightly decreased; however, the pelvic metastasis were unchanged. She exhibited a response in the form of stable disease. However, 12 weeks following the initiation of lenvatinib, she developed a high fever along with excessive leucocytosis. The fever was treated successfully with naproxen; however, the leucocytosis did not reduced. Lenvatinib was stopped, after which the WBC count increased to 70 800 /µL, followed by an increase in granulocyte-colony stimulating factor and serum interleukin-6. Also, she experienced a continued progression of the pulmonary metastasis, a rapid increase in the necrosis of the left pelvic metastasis and developed pleural effusion. Drainage was performed, and cytology was negative. Her treatment was switched to best supportive care. She died after 51 days [immediate cause of death not stated]. She had received lenvatinib for a duration of 5.1 months, and it was noted that she developed anaplastic TC transformation and leucocytosis secondary to lenvatinib.Case 2: The woman, who had a history of papillary TC, surgery ( 2004) and multiple pulmonary metastases ( 2009), received iodine radioactive [radioactive iodine] twice at the age of ~64 years. However, iodine radioactive was ineffective for the pulmonary metastasis, which subsequently increased. She received unspecified thyroid stimulating hormone suppression therapy; however, the pulmonary tumour increased in 2015. At the age of 70 years, she started receiving lenvatinib 24mg, and the dose was decreased to 14mg, and then to 10mg after 12 weeks. She developed lenvatinib-induced grade III HT, grade II arthralgia and grade I alopecia. A partial response to lenvatinib was noted. However, while she had stable disease condition for 56 months following initiation of lenvatinib therapy, the WBC suddenly increased to 19 700 /µL, which indicated leucocytosis. She also developed high fever, which was successfully treated with naproxen. However, the leucocytosis did not subside. A CT scan demonstrated exacerbation of the pulmonar...
