Therapy with tyrosine kinase inhibitor lenvatinib in radioactive iodine-naive advanced differentiated thyroid cancer

• Published in: International journal of endocrine oncology 2019-12, Vol.6 (4)
• Main Authors: Sukumar, Jasmine Singh, Moore, William, Khan, Saad A
• Format: Article
• Language: English
• Subjects: Cancer therapies; differentiated thyroid cancer; Dysphagia; Esophagus; Family medical history; Hypertension; Iodine; lenvatinib; Lymphatic system; Neck; Ostomy; papillary thyroid cancer; Patients; Radiation therapy; radioactive iodine-naive; Surgery; Thyroid cancer; Tumors; tyrosine kinase inhibitor; Ultrasonic imaging
• ISSN: 2045-0869; 2045-0877
• DOI: 10.2217/ije-2019-0007

Preoperative or palliative radiation therapy (with or without systemic therapy) is widely recognized as leading to increased complication rates after head and neck cancer surgery, especially if reconstruction is required (10-14). Any decrease in tumor size with systemic therapy may reduce the extent of surgical interventions such as laryngectomy, tracheal resection and esophageal-pharyngeal resection in favor of less radical surgical approaches. [...]even though the approved indication for lenvatinib is for patients with radioactive iodine refractory thyroid cancer, early systemic therapy may be particularly beneficial in patients with extensively invasive DTC or more aggressive histologies such as poorly differentiated thyroid cancer. While tumor shrinkage may be expected with preoperative lenvatinib, it is unknown what other impact this may have; whether the anti-angiogenic effects of lenvatinib complicate surgery, whether pathologic evidence of lymph node is impaired or if outcomes are improved. External beam radiation 70Gy Myalgias, dysgeusia, weight loss Partial response: - Reduction in paratracheal mass 4.3×1.4→ 1.0×1.0cm - Followed by radioactive iodine and no resumption of lenvatinib for >12months (ongoing) 69 Hispanic F Left thyroid with invasion to trachea and esophagus, cervical and mediastinal lymph nodes, lung None Hypertension, neuropathy, myalgias, weight loss Partial response: - Decrease in size of bilateral pulmonary nodules, mediastinal lymph nodes, and thyroid mass, improvement in malignant pleural effusion - Followed by radioactive iodine (suboptimal response), remains on lenvatinib Patient Patient 1 A 69-year-old Caucasian male presented with 6 months of dyspnea and, in August 2016, a computed tomography (CT) neck scan showed enlargement of the left thyroid with extension into the superior mediastinum and rightward tracheal deviation.