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Lack of efficacy: case report A 72-year-old woman exhibited lack of efficacy during treatment with lenvatinib (initial therapy) and sorafenib for metastatic papillary thyroid carcinoma [routes not stated]. The woman, who had a history of hypertension treated with valsartan, presented with a 1 month history of anterior neck swelling and hoarseness. Based on further investigations, she was diagnosed with papillary thyroid carcinoma. CT scan revealed multiple lymph node and lung metastases. As the tumour was inoperable, she was immediately initiated on lenvatinib 24 mg/day. After 3 months of treatment with lenvatinib, partial response was achieved. During 3 years of response to lenvatinib, dose of lenvatinib was reduced to 4mg every other day due to hypertension and proteinuria. Concomitantly, she received levothyroxine-sodium [Levothyroxine] to suppress serum thyroid-stimulating hormone levels. Subsequently, a new lesion appeared as a subcutaneous nodule on the head. The nodule was resected and nodule histology revealed metastasis of thyroid carcinoma. Furthermore, a CT scan showed an increase in marginal enhancement in the primary lesion. These findings demonstrated that the lesions were refractory to initial lenvatinib therapy. Therefore, the woman’s treatment was switched to sorafenib 400 mg/day. After 5 months of treatment with sorafenib, the tumour showed enlargement and greater uptake of contrast agent, and the serum thyroglobulin level also increased considerably, suggesting progressive disease. Thus, the tumour was considered refractory to both lenvatinib and sorafenib. Therefore, a comprehensive cancer genomic profiling test was performed. While awaiting test results, lenvatinib was restarted at 8 mg/day after 7 months from its discontinuation. Following 3 months of lenvatinib reintroduction, significant shrinkage of the tumour and decrease in its contrast enhancement were observed. Serum thyroglobulin levels had markedly decreased. Hypertension and proteinuria were also noticed. The genomic profiling test revealed RET fusion. Therefore, lenvatinib was stopped, and she was enrolled in a clinical trial of a unspecified selective RET inhibitor. Takinami M, et al. Rechallenge with Lenvatinib after Refractoriness to Initial Lenvatinib Followed by Sorafenib in a Patient with Metastatic Papillary Thyroid Carcinoma. 803519655 Case Reports in Oncology 13: 522-527, No. 2, May-Aug 2020. Available from: URL: http://doi.org/10.1159/000507344

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Reactions 5 Dec 2020 No. 1833