Salvage Lenvatinib Therapy in Metastatic Anaplastic Thyroid Cancer.

Salvage Lenvatinib Therapy in Metastatic Anaplastic Thyroid Cancer.

Thyroid. 2017 May 04;:

Authors: Iniguez Ariza NM, Ryder M, Hilger CR, Bible KC

Abstract
BACKGROUND: Historical anaplastic thyroid cancer (ATC) outcomes have been terrible, with a median survival of only 5 months and <20% 1-year survival. Improved outcomes are now achieved with aggressive initial therapy in stages IVA and IVB disease, but patients with distant metastatic disease (stage IVC) still do poorly; improved therapies are sorely needed. Kinase inhibitors have emerged as promising agents in the therapy of advanced medullary and differentiated thyroid cancer, but there are limited data regarding use of lenvatinib in ATC. The aim of this study was to delineate clinical outcomes in a series of patients with advanced ATC in response to lenvatinib therapy.
METHODS: A retrospective analysis was conducted involving all lenvatinib-treated Mayo Clinic ATC patients during the year 2015.
RESULTS: Of twenty eight distinct ATC patients seen in 2015, three with metastatic disease (11%) of ECOG performance status 2-3 were treated with lenvatinib. Two patients were male; age range at ATC diagnosis was 57 to 84 years. All three patients attained successful local control of their disease with surgery and/or combined chemo-radiotherapy. Lenvatinib was offered as second, third or fourth line of therapy at time of metastatic disease progression. Two patients incurred minor responses to therapy, with structural regression of distant metastatic tumor disease soon after starting lenvatinib treatment (at 1 to 2 months), while one patient achieved stable disease - but no RECIST PRs resulted. Overall survival after starting lenvatinib was 2, 6 and 7 months. Fatigue and hypertension were prominent, and one patient developed pulmonary emboli while on lenvatinib.
CONCLUSION: Our initial single-institution experience suggests that lenvatinib may have some disease-modifying activity in metastatic ATC that is otherwise refractory to cytotoxic chemotherapy. Unfortunately, observed benefits were transient, and toxicities prominent. Clinical trials are required to better ascertain the utility of lenvatinib in the management of advanced ATC.

PMID: 28471306 [PubMed - as supplied by publisher]

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