Lenvatinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer: Treatment Optimization for Maximum Clinical Benefit.
differentiated thyroid cancer
lenvatinib
radioiodine refractory
systemic therapy
toxicity
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
05 07 2022
05 07 2022
Historique:
received:
20
10
2021
accepted:
24
02
2022
pubmed:
29
4
2022
medline:
7
7
2022
entrez:
28
4
2022
Statut:
ppublish
Résumé
Lenvatinib is a multitargeted tyrosine kinase inhibitor approved for treating patients with locally recurrent or metastatic progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC). In this review, we discuss recent developments in the optimization of RR-DTC treatment with lenvatinib. Initiation of lenvatinib treatment before a worsening of Eastern Cooperative Oncology Group performance status and elevated neutrophil-to-lymphocyte ratio could benefit patients with progressive RR-DTC. The median duration of response with lenvatinib was inversely correlated with a smaller tumor burden, and prognosis was significantly worse in patients with a high tumor burden. An 18 mg/day starting dose of lenvatinib was not noninferior to 24 mg/day and had a comparable safety profile. Timely management of adverse events is crucial, as patients with shorter dose interruptions benefitted more from lenvatinib treatment. Caution should be exercised when initiating lenvatinib in patients who have tumor infiltration into the trachea or other organs, or certain histological subtypes of DTC, as these are risk factors for fistula formation or organ perforation. The Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid (SELECT) eligibility criteria should be considered prior to initiating lenvatinib treatment. Current evidence indicates that patients benefit most from lenvatinib treatment that is initiated earlier in advanced disease when the disease burden is low. A starting dose of lenvatinib 24 mg/day, with dose modifications as required, yields better outcomes as compared to 18 mg/day. Appropriate supportive care, including timely identification of adverse events, is essential to manage toxicities associated with lenvatinib, avoid longer dose interruptions, and maximize efficacy.
Sections du résumé
BACKGROUND
Lenvatinib is a multitargeted tyrosine kinase inhibitor approved for treating patients with locally recurrent or metastatic progressive radioiodine-refractory differentiated thyroid cancer (RR-DTC). In this review, we discuss recent developments in the optimization of RR-DTC treatment with lenvatinib.
SUMMARY
Initiation of lenvatinib treatment before a worsening of Eastern Cooperative Oncology Group performance status and elevated neutrophil-to-lymphocyte ratio could benefit patients with progressive RR-DTC. The median duration of response with lenvatinib was inversely correlated with a smaller tumor burden, and prognosis was significantly worse in patients with a high tumor burden. An 18 mg/day starting dose of lenvatinib was not noninferior to 24 mg/day and had a comparable safety profile. Timely management of adverse events is crucial, as patients with shorter dose interruptions benefitted more from lenvatinib treatment. Caution should be exercised when initiating lenvatinib in patients who have tumor infiltration into the trachea or other organs, or certain histological subtypes of DTC, as these are risk factors for fistula formation or organ perforation. The Study of (E7080) LEnvatinib in Differentiated Cancer of the Thyroid (SELECT) eligibility criteria should be considered prior to initiating lenvatinib treatment.
CONCLUSIONS
Current evidence indicates that patients benefit most from lenvatinib treatment that is initiated earlier in advanced disease when the disease burden is low. A starting dose of lenvatinib 24 mg/day, with dose modifications as required, yields better outcomes as compared to 18 mg/day. Appropriate supportive care, including timely identification of adverse events, is essential to manage toxicities associated with lenvatinib, avoid longer dose interruptions, and maximize efficacy.
Identifiants
pubmed: 35482606
pii: 6575578
doi: 10.1093/oncolo/oyac065
pmc: PMC9256022
doi:
Substances chimiques
Antineoplastic Agents
0
Iodine Radioisotopes
0
Phenylurea Compounds
0
Protein Kinase Inhibitors
0
Quinolines
0
lenvatinib
EE083865G2
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
565-572Informations de copyright
© The Author(s) 2022. Published by Oxford University Press.
Références
J Natl Cancer Inst. 2014 May 29;106(6):dju124
pubmed: 24875653
N Engl J Med. 2021 Apr 8;384(14):1289-1300
pubmed: 33616314
Clin Adv Hematol Oncol. 2016 May;14(5 Suppl 9):3-6
pubmed: 27168341
Oncologist. 2016 Jan;21(1):50-8
pubmed: 26675742
Thyroid. 2017 Sep;27(9):1135-1141
pubmed: 28665259
Case Rep Endocrinol. 2020 May 11;2020:6438352
pubmed: 32455032
Horm Metab Res. 2020 Aug;52(8):562-577
pubmed: 32040962
Cancers (Basel). 2021 May 10;13(9):
pubmed: 34068664
BMC Cancer. 2019 Dec 12;19(1):1209
pubmed: 31830943
Cancer Chemother Pharmacol. 2018 Dec;82(6):971-978
pubmed: 30244318
J Clin Oncol. 2017 Aug 10;35(23):2692-2699
pubmed: 28613956
Endocr J. 2020 Jul 28;67(7):669-717
pubmed: 32269182
Cancers (Basel). 2019 Sep 17;11(9):
pubmed: 31533238
Front Endocrinol (Lausanne). 2020 Jan 08;10:884
pubmed: 31998228
J Thyroid Res. 2012;2012:618985
pubmed: 22530159
Thyroid. 2021 Aug;31(8):1226-1234
pubmed: 33637020
Oncotarget. 2017 Oct 19;8(58):98974-98984
pubmed: 29228742
Int J Surg Case Rep. 2017;41:89-92
pubmed: 29055877
JAMA Otolaryngol Head Neck Surg. 2014 Apr;140(4):317-22
pubmed: 24557566
Eur Thyroid J. 2021 Jul;10(5):399-407
pubmed: 34540710
J Clin Endocrinol Metab. 2016 Jul;101(7):2733-41
pubmed: 27082933
J Endocr Soc. 2018 Nov 21;3(2):359-371
pubmed: 30706042
Front Endocrinol (Lausanne). 2017 Nov 20;8:312
pubmed: 29209273
N Engl J Med. 2022 Feb 3;386(5):437-448
pubmed: 35045221
Eur Thyroid J. 2019 Oct;8(5):227-245
pubmed: 31768334
Clin Pharmacol Ther. 2017 Nov;102(5):765-776
pubmed: 28699160
Best Pract Res Clin Endocrinol Metab. 2017 Jun;31(3):349-361
pubmed: 28911730
Cancer Treat Rev. 2016 Jan;42:47-55
pubmed: 26678514
Crit Rev Oncol Hematol. 2021 Jan;157:103186
pubmed: 33309571
Ann Oncol. 2019 Dec 1;30(12):1856-1883
pubmed: 31549998
Endocr Relat Cancer. 2018 Jun;25(6):699-704
pubmed: 29752332
Lancet. 2014 Jul 26;384(9940):319-28
pubmed: 24768112
Otolaryngol Clin North Am. 2010 Apr;43(2):229-38, vii
pubmed: 20510711
N Engl J Med. 2015 Feb 12;372(7):621-30
pubmed: 25671254
J Clin Endocrinol Metab. 2022 Feb 17;107(3):776-787
pubmed: 34664662
Thyroid. 2014 Jul;24(7):1179-83
pubmed: 24684401
Semin Oncol. 2019 Feb;46(1):57-64
pubmed: 30685073
J Endocrinol Invest. 2021 Mar;44(3):403-419
pubmed: 32743746
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
Clin Oncol (R Coll Radiol). 2020 May;32(5):e145-e153
pubmed: 31843241
Ther Adv Med Oncol. 2014 Nov;6(6):267-79
pubmed: 25364392
Eur J Cancer. 2021 Apr;147:51-57
pubmed: 33611104
Eur J Cancer. 2019 Jan;106:61-68
pubmed: 30471649
Head Neck. 2019 Sep;41(9):3023-3032
pubmed: 31013380
Drug Des Devel Ther. 2016 Feb 29;10:873-84
pubmed: 27013865