Lenvatinib induces early tumor shrinkage in patients with advanced thyroid carcinoma.

Abstract

Although advanced thyroid carcinoma patients who cannot be cured by conventional therapy have lacked effective treatment, multitargeted tyrosine kinase inhibitors have recently become available. Phase 3 trials of lenvatinib showed a median time to objective response of 2 (95 % confidence interval (CI) 1.9-3.5) months, demonstrating that shrinks tumors rapidly. The phenomenon of immediate tumor shrink is known as early tumor shrinkage (ETS) which is related to clinical outcome in other malignancies. However, precisely when within 8 weeks lenvatinib starts to affect tumors remains unclear. In tumors near the carotid arteries, trachea, or esophagus, a rapid therapeutic effect can induce fistula formation or arterial bleeding. To prevent such treatment-emergent serious adverse events (SAE), early imaging evaluation seems to be very important. In this study, the point in time when lenvatinib started to shrink tumors was retrospectively investigated. The subjects were 16 patients who started lenvatinib administration between May and August 2015. Tumor size was evaluated by computed tomography (CT) scans frequently within the first 8 weeks according to the Response Evaluation Criteria In Solid Tumors (RECIST) guideline. Initial tumor response was defined as ≥ 10% tumor reduction. Serum thyroglobulin (Tg) level was monitored in 8 differentiated thyroid carcinoma (DTC) without TgAb patients. At the first evaluation, 13 patients (83.3 %) showed tumor reduction and that decreased with time. Thirteen patients (83.3 %) showed >10 % tumor reduction within 8 weeks. In all DTC patients, serum Tg level was markedly decreased. In conclusion, lenvatinib immediately shrinks tumors, the so-called ETS phenomenon. Therefore, careful attention should be paid to fistula formation from the early phase.

• Authors: Chie Masaki, Kiminori Sugino, Naoko Saito, Yoshiyuki Saito, Tomoaki Tanaka, Yuna Ogimi, Tetsuyo Maeda, Tadatoshi Osaku, Junko Akaishi, Kiyomi Y Hames, Chisato Tomoda, Akifumi Suzuki, Kenichi Matsuzu, Takashi Uruno, Keiko Ohkuwa, Wataru Kitagawa, Mitsuji Nagahama, Hiroshi Takami, Koichi Ito
• Journal: Endocrine journal (Endocr J) Vol. 64 Issue 8 Pg. 819-826 (Aug 30 2017) ISSN: 1348-4540 [Electronic] Japan
• PMID: 28659544 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Phenylurea Compounds
• Quinolines
• lenvatinib

Topics

• Adenocarcinoma, Follicular (diagnostic imaging, drug therapy, pathology)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Carcinoma, Medullary (diagnostic imaging, drug therapy, pathology)
• Carcinoma, Papillary (diagnostic imaging, drug therapy, pathology)
• Female
• Humans
• Male
• Middle Aged
• Phenylurea Compounds (therapeutic use)
• Quinolines (therapeutic use)
• Thyroid Gland (diagnostic imaging, pathology)
• Thyroid Neoplasms (diagnostic imaging, drug therapy, pathology)
• Tomography, X-Ray Computed
• Treatment Outcome