Lenvatinib as first-line treatment for advanced thyroid cancer: long progression-free survival
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ORIGINAL ARTICLE
Lenvatinib as first-line treatment for advanced thyroid cancer: long progression-free survival Simone De Leo1 Marta Di Stefano2 Luca Persani1,2 Laura Fugazzola ●
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Carla Colombo1,3
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Received: 13 June 2020 / Accepted: 23 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Lenvatinib (LEN) has been approved for the treatment of patients with progressive radioiodine-refractory differentiated thyroid cancer (RAI-R DTC). Real-life studies reported a lower progression-free survival (PFS) than the registration study, likely due to the more advanced stage of tumors, the more frequent pretreatment with other TKIs, the limited followup, and the worse clinical condition of the patients included. Methods We evaluated the clinical data of our cohort of 13 consecutive patients, all receiving LEN as a first-line TKI treatment, and followed-up in a single tertiary Center. Results All patients had an ECOG of 0–1 and regional or distant metastases were documented in 61.5% and 77% of patients, respectively. Median PFS was 22 months (95% CI 14–35) with partial response in 69% and stable disease in 31% of patients. All patients experienced at least one adverse event (AE), the most frequent being fatigue, anorexia, diarrhea, and hypertension. The daily dose was reduced in 70% of patients and only one patient (7.7%) discontinued the drug for AEs. Conclusion In this series of RAI-R DTC patients, with the unique features to have an ECOG 0 or 1 and to be naive for TKI treatments, PFS was the longest among all real-life published so far, with the highest rate of patients with partial response and one of the lowest drug discontinuation rate for AEs. The correct timing of treatment start, the tailoring of the dose, and a proper management of the AEs may have a significant impact on the treatment response to LEN. Keywords Lenvatinib Progression-free survival Real-life Tyrosine-kinase inhibitor ●
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Introduction Differentiated thyroid cancer has an excellent prognosis. However, overall survival is significantly worsened if patients develop distant metastasis or become radioactive iodine (RAI) refractory (RAI-R) [1]. The definition of RAIrefractoriness is still debated. In patients with progressive RAI-refractory thyroid cancer and in whom a local treatment is not feasible, a systemic therapy with a multi-kinase inhibitors is used [2, 3]. Only two TKIs have been licensed
* Laura Fugazzola [email protected] 1
Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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for RAI-R DTC treatment, sorafenib, licensed in the United States (US) in November 2013 and in the European Union (EU) in January 2015, and lenvatinib (LEN) receiving a license in the US in February 2015 and in the EU in May 2015. LEN, which is the on
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