Cancer Management and Research (Sep 2021)
Low Dose of Lenvatinib Treatment for Patients of Radioiodine-Refractory Differentiated Thyroid Carcinoma – A Real-World Experience
Abstract
He-Jiun Jiang,1 Yen-Hsiang Chang,2 Yen-Hao Chen,3 Che-Wei Wu,4 Pei-Wen Wang,5 Pi-Jung Hsiao6 1Division of Endocrinology and Metabolism, Department of Internal Medicine, E-DA DaChang Hospital, Kaohsiung, Taiwan; 2Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Department of Hematology-Oncology, Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan; 4Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Division of Endocrinology and Metabolism, Department of Internal Medicine; Department of Nuclear Medicine; Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan; 6Division of Endocrinology and Metabolism, Department of Internal Medicine, E-DA Hospital; Thyroid Center, E-DA Cancer Hospital; College of Medicine, I-Shou University, Kaohsiung, TaiwanCorrespondence: Pi-Jung HsiaoDivision of Endocrinology and Metabolism, Department of Internal Medicine, E-DA Hospital; Thyroid Center, E-DA Cancer Hospital; College of Medicine, I-Shou University, No. 1, Yida Road, Yanchao District, Kaohsiung, 82445, TaiwanTel +886-7-6150011 ext 2325Fax +886-7-5581421Email [email protected]: Lenvatinib treatment of 24 mg/day for radioiodine-refractory differentiated thyroid carcinoma (RRDTC) patients was almost intolerable, with high rates of dose reduction, interruption and discontinuation. Balancing treatment safety with disease risks remains challenging, and the appropriate dosage remains unclear in Asia.Patients and Methods: A total of 65 RRDTC patients treated with lenvatinib were retrospectively collected from Oct. 2015 to Jun. 2020 from two medical centers of South Taiwan. The drug tolerability, treatment efficacy and clinical outcomes were analyzed.Results: Different doses of lenvatinib were initiated but ultimately maintained with a median dose of 10 mg/day within the first 3 months. The disease control rate reached 89.2%, including 24.6% partial response and 64.6% stable disease. Disease progression occurred in 10.8% of patients and increased to 40.0% at the end. Eventually, the treatment dose achieved a median progression-free survival (PFS) of 26.1 months (95% CI: 17.1-NA) with overall survival (OS) not reached yet (24.1∼NA). Overall, the 48-month PFS rate was 35.6% (95% CI: 18.5– 68.4) and 48-month OS was 54.3% (95% CI: 41.2– 71.7). The dose was tolerable with a dose reduction rate of 44.6%, dose interruption rate of 40.0% and fewer high-graded adverse events. The drug discontinuation rate was only 3.1%. However, RRDTC patients with bone metastasis or maximal dose exposure to RAI (≥ 600 mCi) may have less efficacy to the low maintenance dose treatment.Conclusion: Assessing treatment intensity, safety and efficacy, low-dose lenvatinib treatment was well tolerated by RRDTC patients and displayed acceptable drug efficacy and outcomes.Keywords: lenvatinib, radioiodine-refractory differentiated thyroid carcinoma, RRDTC, disease control rate, DCR, progression-free survival, PFS, overall survival, OS
