Real-world lenvatinib use in metastatic thyroid cancer: early dose intensity and side effect profile in a Sydney centre
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Objective: Lenvatinib is a multi-kinase inhibitor approved in radioiodine-refractory thyroid cancer based on results of a phase III trial. Real-world data has emphasised concerns regarding tolerability of the starting dose (24mg/day) and frequency of dose-limiting treatment-related adverse effects (TRAEs). We aimed to assess early dose intensity, tolerability and efficacy using lenvatinib in metastatic thyroid cancer patients in an Australian centre.
Design/Methods: Retrospective medical record review was conducted of patients with advanced/metastatic differentiated, medullary and anaplastic thyroid cancer on lenvatinib at a quaternary referral centre (2014-2023).
Results: 64 patients were included. Median age at lenvatinib commencement was 67-years (range 38-92). 53% were female. Most common non-nodal metastases were pulmonary (86.4%) and skeletal (50.8%). Most patients commenced lenvatinib at 24mg/day (48/53; 90.5%), with less than half maintaining this dose by 8-weeks (21/45; 46.7%). Those who maintained 24mg dose at 8-weeks were younger at lenvatinib commencement (62-years vs 71-years, p=0.016) and more likely to have poorly differentiated or anaplastic thyroid cancer (42% vs 22%, p=0.018). During median 12-months follow-up, most common TRAEs included hypertension (n=37), fatigue (n=35), and nausea (n=18). In a subgroup of 21/35 patients with differentiated thyroid cancer, median baseline and nadir serum thyroglobulin were 305 μg/L and 21.7 μg/L (median reduction 92.5% (IQR 81.1-98.0%)). In 19/35 patients with radiological response data, majority experienced disease control as best structural response (17/19; 93.2%).
Conclusion: This real-world analysis demonstrates difficulties in maintaining early lenvatinib dose intensity with frequent TRAEs. Greater emphasis on supportive care is needed to maximise early dose intensity and efficacy.
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