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Long-term management of lenvatinib-treated thyroid cancer patients: a real-life experience at a single institution

Endocrine volume 73, pages 358–366 (2021)Cite this article

Abstract

Purpose

The efficacy of lenvatinib for advanced and progressive radioactive iodine refractory differentiated thyroid cancer is well established. Herein, we retrospectively evaluated the long-term safety and efficacy of lenvatinib in 23 patients treated at a single Institution.

Methods

Clinical data of all patients treated for a differentiated thyroid cancer with lenvatinib from April 2015 to September 2020 were retrospectively analyzed.

Results

A total of 23 patients were included. In all, 21 patients received lenvatinib as first-line systemic therapy. Median age at initiation of lenvatinib treatment was 68 (44–90) years. Median duration of the study from initiation of lenvatinib to study end was 23 (2–65) months. The indication for lenvatinib treatment was documented progression of distant metastases in 20 patients and of locally advanced disease in the other 3 and median duration of lenvatinib therapy was 15 (2–64) months. Best treatment responses were: partial response in 6 patients, stable disease in 14, progressive disease in 1, and not evaluable in 2. Median progression-free survival was 25 months (95% CI: 12–40) and median overall survival was 46 months (95% CI: 28–65). Three patients had to discontinue lenvatinib treatment due to serious adverse events and no drug-related death was observed. Ten patients continued lenvatinib for more than 24 months and the only newly registered adverse event after this period of time was one case of G2 proteinuria. Six patients continued lenvatinib treatment beyond documented tumor progression due to oligoprogression or slowly progressive disease (median time 18.5 months, 8–42 months). A total of 14 patients were alive at the end of the study: 11 showed partial response/stable disease on lenvatinib, including 3 who had a stable disease after local ablative therapy for oligoprogressive metastases; 3 had to change treatment, including 2 for lenvatinib-related serious adverse events and 1 for progressive disease.

Conclusions

Long-term lenvatinib treatment is safe and some patients may experience persistent long-term control of the disease. Late treatment-related AEs rarely occurred. Oligoprogressive and slowly progressive disease can be managed without treatment withdrawal as long as there are some clinical benefits.

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Acknowledgements

F.S. contributed to this paper as part of her PhD in Public Health at the University of Naples “Federico II.”

Funding

The study was supported by the PRIN 2017 project prot. 2017YTWKWH.

Author contributions

T.P., C.L., F.S., M.K., S.M., G.T., C.B., and D.S. managed the patients. T.P. and D.S. designed the study. T.P., C.L., and F.S. collected the data. T.P. analyzed the data and wrote the manuscript. M.S. and D.S. revised the manuscript. All the authors approved the final manuscript and agreed to be accountable for the content of the work.

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Affiliations

  1. Department of Public Health, University of Naples “Federico II”, 80131, Naples, Italy

    Tommaso Porcelli, Cristina Luongo, Francesca Sessa, Giancarlo Troncone, Claudio Bellevicine & Domenico Salvatore

  2. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy

    Michele Klain

  3. Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

    Stefania Masone

  4. Department of Endocrine Oncology, Gustave Roussy and University Paris-Saclay, 94805, Villejuif, France

    Martin Schlumberger

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  1. Tommaso Porcelli
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  2. Cristina Luongo
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  9. Domenico Salvatore
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Correspondence to Tommaso Porcelli.

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This study was approved by Institutional Review Board of the University Hospital “Federico II” of Naples.

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All patients provided written informed consent for research participation and for the publication of indirectly identifiable data.

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Porcelli, T., Luongo, C., Sessa, F. et al. Long-term management of lenvatinib-treated thyroid cancer patients: a real-life experience at a single institution. Endocrine 73, 358–366 (2021). https://doi.org/10.1007/s12020-021-02634-z

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  • DOI: https://doi.org/10.1007/s12020-021-02634-z

Keywords

  • Thyroid cancer
  • Real-life
  • Lenvatinib
  • Tyrosine kinase inhibitors
  • Long-term management