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Lenvatinib effective, but challenging for prescribers, patients
Adults with radioactive iodine-resistant differentiated thyroid cancer may achieve partial remission with lenvatinib treatment, but adverse events are common and early interventions may be required, according to findings published in Endocrine Practice.
“Lenvatinib is an effective therapy in radioactive idodine-resistant differentiated thyroid cancer, but presents challenges to patients and prescribers alike due to considerable adverse effects that require expeditious responsive actions and often dosage reductions,” Keith C. Bible, MD, PhD, of the division of medical oncology at the Mayo Clinic, told Endocrine Today.
Bible and colleagues evaluated 25 adults (median age, 55 years; 52% women) with progressive, metastatic radioactive iodine-resistant differentiated thyroid cancer to determine the safety and efficacy of lenvatinib (Lenvima, Eisai). Fifty-six percent of participants were prescribed antihypertensive medication at baseline. Most participants had a starting lenvatinib dose of 24 mg, but dose was reduced in four participants due to older age, renal impairment or prior colitis.
Adverse events developed in 84% of participants and required interventions during the first month of therapy; 64% developed hypertension, 40% were grade three or higher, and 28% had new-onset hypertension. Dose adjustment for antihypertensive medication was required in 24% of participants, and nearly half of participants needed additional treatment in the first month.
A dose reduction for lenvatinib due to adverse events was required in 44% of participants with a median time to dose reduction of 33 days. The mean duration of lenvatinib therapy was 6.5 months; 28% of participants discontinued treatment due to disease progression or adverse events.
Among 20 participants with available response evaluation criteria in solid tumors, 50% achieved partial response.
”There are defined and specific precautions that can and should be implemented by providers, prescribers and patients in collaboration to optimize the safety and efficacy of lenvatinib therapy,” Bible said. “Additional studies of the effects of lenvatinib therapy on patient quality of life are needed.” – by Amber Cox
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Keith C. Bible, MD, PhD, can be reached at bible.keith@mayo.edu.
Disclosures: The authors report no relevant financial disclosures.