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Lenvatinib/pembrolizumab Fatigue and diarrhoea following an off-label use of lenvatinib and pembrolizumab: case report A 55-year-old man developed minimal fatigue and mild diarrhoea while receiving an off-label therapy with lenvatinib and pembrolizumab for heavily metastasised poorly differentiated thyroid carcinoma. The man had heavily metastasised poorly differentiated thyroid carcinoma with rapid progression despite multimodal therapy comprising thyroidectomy, lymph node dissection, cervical irradiation, radioiodine therapy, denosumab, lenvatinib, sorafenib, pemetrexed, paclitaxel and pazopanib. In December 2017, he started receiving an off-label therapy with lenvatinib 20–24 mg/day and pembrolizumab 200mg every 3 weeks [routes not stated]. Tumour staging every 3 months showed a rapid response with a significant improvement in the underlying condition. On a follow-up visit in September 2019, his thyroglobulin levels were found to be constantly decreased. The off-label therapy with lenvatinib and pembrolizumab was well tolerated with development of minimal fatigue and mild diarrhoea [outcomes not stated]. Author comment: "[Lenvatinib and pembrolizumab] is well tolerated without major side effects (minimal fatigue, mild diarrhoea)." Koehler VF, et al. Induction of long-term partial remission in a patient with heavily pretreated poorly differentiated thyroid carcinoma (PDTC) with disseminated metastatic disease on lenvatinib in combination with pembrolizumab. Thyroid 29 (Suppl. 1): A108 (plus poster) abstr. 305, Oct 2019. Available from: URL: http://doi.org/10.1089/thy.2019.29085.abstracts [abstract] 803437017 Germany

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Reactions 30 Nov 2019 No. 1781