Lenvatinib in Metastatic DTC (Differentiated Thyroid Cancer)- A Pragmatic Approach with Dosing
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 1
Abstract
Thyroid cancer has become one of the fastest-increasing cancers in recent years. There are nearly 300,000 new cases of thyroid cancer annually and approximately 40,000 people die from thyroid cancer worldwide each year [1]. Differentiated thyroid cancer is a highly treatable and curable cancer (DTC). 90% of the patients with DTC will be alive at 10 yrs after the diagnosis. However, in patients who develop radio iodine resistance these survival rates are reduced down to 10% over the same period [2- 4]. After a long struggle of finding a suitable alternative to largely ineffective treatment with chemotherapy, Multikinase Inhibitors Sorafenib and Lenvatinib after demonstrated success in Decision [5] and Select [6] trials respectively, have gained FDA and EMA approval for the treatment of Radio iodine refractory Differentiated Thyroid Cancers ( RR-DTC). Although effective, these agents as a class effect carry a considerable toxicity profile. In both the registration trials, a significant portion of patients required dose modifications in order to maintain compliance and tolerability. Common toxicities of fatigue, hypertension, palmoplantar effect diarrhoea and weight loss of more than 10% and proteinuria played a common theme effecting majority of the patients. In the SELECT trial 67.8% of the patients required dose modifications and although the intended dose was 24mg, median dose was calculated at 17.2 mg. The time for first dose reduction was observed at 3 months. We present a real time experience of cases with RR DTC treated with Lenvatinib at our facility that fall outside of the spectrum of patients recruited to the trials as above. In view of rapid onset of toxicities or co morbidities we initiated the treatment at a dose of 14mg which proved to be reasonably well tolerated and effective with demonstrable clinical responses within 1 month of initiation of treatment.
Authors and Affiliations
Arif Shaukat, Ansari J
Keywords
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- EP ID EP567596
- DOI 10.26717/BJSTR.2017.01.000156
- Views 181
- Downloads 0
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