Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Lenvatinib in metastatic radioiodine refractory thyroid cancer - a single centre experience (#334)

Michael McLucas 1 , Hiren Mandaliya 2 , Shaun McGrath 2 , Girish Mallesara 2
  1. University of Newcastle, Newcastle, NSW , Australia
  2. Calvary Mater , Newcastle, NSW , Australia

Background

Lenvatinib is a multi-receptor tyrosine kinase inhibitor used in the treatment of metastatic radioiodine-refractory differentiated thyroid cancer. Lenvatinib improves progression-free survival; however, this must be weighed against its potential adverse effects. We describe single centre experience with Lenvatinib.

Methods

A retrospective analysis was carried out. Patients treated with Lenvatinib for metastatic, radioiodine-refractory thyroid cancer at Calvary Mater Newcastle between March 2016 and September 2017 were identified. Information on their demographics and pattern of care was collected.

Results

Nine patients, aged 56-74 years, were treated. Six patients were male (67%) and three were female. Five patients (56%) had papillary cancer and four (44%) had follicular cancer, including one with Hürthle cell cancer. Most common site of metastasis was lungs (8 patients) followed by bones (4) and liver (3). Two patients had prior Sorafenib.

Three patients (33%) had partial response and six patients (67%) had stable disease as per RECIST criteria. Four patients ceased treatment because of progression, two patients continued treatment and one patient is on hold because of toxicity. Two patients died whilst treated; one due to disease progression and another secondary to cardiac comorbidity. The duration on Lenvatinib ranged between six and 40 months.

All patients either developed new-onset hypertension or pre-existing hypertension worsened. Hoarseness of voice, mucositis including diarrhoea, fatigue, and weight loss occurred in five patients (44%).  Palmar plantar erythrodysesthesia occurred in three patients. Toxicities generally improved with dose reduction. No patient was able to tolerate the recommended starting dose of 24mg for extended periods. Seven patients continued treatment at a dose range of 14-20mg.

Conclusions

Lenvatinib appeared relatively effective in this population. Judicious dose adjustment and interruption allowed patients and clinicians to find a tolerable, appropriate dosage. Our experience suggests a lower starting dose of Lenvatinib may be a worthwhile consideration in this population.

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