Successful treatment switch from lenvatinib to sorafenib in a patient with radioactive iodine-refractory differentiated thyroid cancer intolerant to lenvatinib due to severe proteinuria.

Abstract

Sorafenib and lenvatinib showed efficacy for patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) in pivotal phase 3 clinical trials. Although the efficacy of lenvatinib in patients who received previous treatment with multi-target kinase inhibitors (m-TKIs), including sorafenib, was reported, the efficacy of sorafenib in patients who previously received lenvatinib remains unknown. A 75-year-old woman diagnosed as RAI-refractory poorly differentiated carcinoma with multiple lung metastases and started treatment with lenvatinib. She continued to receive lenvatinib but with repeated dose interruptions and reductions due to continuous proteinuria. Because of severe and persistent proteinuria as well as newly developed renal impairment, lenvatinib was suspended after two years of treatment. After the 7-month suspension, her proteinuria and renal impairment were partially improved, but her lung metastases progressed. Because she was unable to tolerate previous treatment with lenvatinib, sorafenib was started. At 7 months of treatment with sorafenib, her lung metastases shrank and she could continue sorafenib without exacerbation of proteinuria or renal impairment. This case may suggest that sorafenib does not exacerbate the proteinuria or renal impairment induced by lenvatinib, and may be an effective treatment option for RAI-refractory DTC patients who are unable to tolerate lenvatinib.

• Authors: Hideaki Goto, Naomi Kiyota, Naoki Otsuki, Yoshinori Imamura, Naoko Chayahara, Hirotaka Suto, Yoshiaki Nagatani, Masanori Toyoda, Toru Mukohara, Ken-Ichi Nibu, Toshihiko Kasahara, Yasuhiro Ito, Akihiro Miya, Mitsuyoshi Hirokawa, Akira Miyauchi, Hironobu Minami
• Journal: Auris, nasus, larynx (Auris Nasus Larynx) Vol. 45 Issue 6 Pg. 1249-1252 (Dec 2018) ISSN: 1879-1476 [Electronic] Netherlands
• PMID: 29779695 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Chemical References

• Antineoplastic Agents
• Iodine Radioisotopes
• Phenylurea Compounds
• Quinolines
• Sorafenib
• lenvatinib

Topics

• Aged
• Antineoplastic Agents (adverse effects, therapeutic use)
• Drug Substitution
• Female
• Humans
• Iodine Radioisotopes
• Lung Neoplasms (diagnostic imaging, drug therapy, radiotherapy, secondary)
• Phenylurea Compounds (adverse effects)
• Proteinuria (chemically induced)
• Quinolines (adverse effects)
• Radiation Tolerance
• Sorafenib (therapeutic use)
• Thyroid Cancer, Papillary (drug therapy, radiotherapy)
• Thyroid Neoplasms (diagnostic imaging, drug therapy, pathology, radiotherapy)
• Tomography, X-Ray Computed
• Treatment Outcome