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Various toxicities: case report A 65-year-old man exhibited lack of efficacy following treatment with iodine-131 for thyroid cancer. Subsequently, he developed constipation, mucositis, myalgia, anorexia and acute pancreatitis following treatment with lenvatinib for thyroid cancer [routes not stated; not all dosages and outcomes stated]. The man, who had follicular thyroid cancer, underwent thyroidectomy. Twenty years after the surgery, recurrence of thyroid cancer was noted. He underwent left lung metastasectomy. Thereafter, from 2010 to 2012, he received three consecutive treatments with radioactive iodine-131. After 5 years of observation, he developed symptoms such as frequent cough and chest pain in December 2017. He was diagnosed with aggravated lung metastases. The thyroid cancer was deemed to be refractory to iodine-131 therapy. The man started receiving lenvatinib 24 mg/day. After two weeks, he developed various adverse effects such as grade 3 anorexia, grade 2 constipation, grade 2 myalgia and grade 3 mucositis. Therefore, lenvatinib dose was decreased to 20 mg/day. Twenty days after the dose reduction, he was hospitalised with complaints of acute onset persistent epigastric pain and indigestion. He did not have fever, dyspnoea or diarrhoea. He had mild abdominal distension with hypoactive bowel sounds. Physical examination revealed mid-epigastric tenderness to palpitation. A CT scan with contrast enhanced revealed heterogeneous fluid collection around and fat infiltration into the tail of the pancreas, in addition to splenic subcapsular fluid collection and secondary colitis at the descending colon, without any biliary abnormalities. Thyroid cancer burden had mildly improved. He was diagnosed with mild acute pancreatitis secondary to lenvatinib therapy. Lenvatinib was discontinued. He was treated with IV hydration and unspecified medications for pain control. On admission day 14, he could consume oral food without recurrence or aggravation of acute pancreatitis. Subsequently, he was discharged with improvement. He refused to continue lenvatinib therapy and therefore was only being monitored for symptoms without additional chemotherapy. Kim HJ, et al. Lenvatinib-induced acute pancreatitis in a patient with metastatic thyroid cancer: A case report. International Journal of General Medicine 13: 699-704, 2020. 803516409 Available from: URL: http://doi.org/10.2147/IJGM.S272375

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Reactions 21 Nov 2020 No. 1831