Thyroid : official journal of the American Thyroid Association 2017 10 19() doi 10.1089/thy.2017.0205
In the SELECT phase III trial in advanced radio-iodine refractory differentiated thyroid cancer (rDTC), lenvatinib improved median progression free survival (PFS) over placebo by almost 15 months and induces an objective response rate of 64.8%, but adverse events occurred in almost all patients. The present study evaluates the efficacy and toxicity of lenvatinib treatment in real-life practice.
Clinical charts of 88 consecutive patients treated with lenvatinib from July 2015 to June 2016 in 27 French centers were retrospectively reviewed. Patients treated for other thyroid cancer types (n=11) or previously treated with lenvatinib within a trial (n=2) were excluded and the remaining 75 rDTC patients formed the basis of this report.
75 rDTC patients were analyzed (33 females, median age: 65 years [35-88]), 12 had ECOG performance status ≥2; 24 cases received lenvatinib as first line systemic treatment; 47 (63%) patients had documented progressive disease prior to treatment initiation. Distant metastases were located in lungs, bones and lymph nodes in 89%, 60% and 69%, respectively. Initial treatment dose was 24 mg in 54 patients and was lower in the other 21 patients. The median follow-up was 7 months, with a median duration of treatment of 6 months [0.3-15]. Median PFS was 10 months. Among the 65 patients with evaluation of tumor response during treatment, best tumor response was a partial response in 23 patients (31%) and stable disease in 38 (51%). Eleven patients (14.7%) discontinued lenvatinib for disease progression. Forty-four (59%) and 23 (31%) patients had dose reduction or interruption of lenvatinib for adverse events (AEs). The most frequent AEs related to treatment were fatigue, hypertension, weight loss, diarrhea and anorexia. Eleven deaths occurred during study (one considered to be drug related). Pneumothorax occurred in 2 patients with lung metastases.
Real-life patients with rDTC can benefit from lenvatinib treatment. AEs are frequent and should be closely monitored.