Abstract
Anaplastic thyroid carcinoma (ATC) is a fatal disease with a poor prognosis. Lenvatinib is an oral multi-targeted tyrosine kinase inhibitor (TKI) which is approved in Japan for the treatment of ATC. Data of treatment response and adverse effects of lenvatinib in ATC patients is still relatively scarce, especially in non-Japanese patient populations. Here we report dramatic treatment effects of lenvatinib in two patients with stage IVc ATC, who later developed significant morbidities including tracheal perforation and fistula formation. Our cases demonstrate the efficacy and provide cautionary information for treatment of ATC. In treating advanced ATC patients with lenvatinib, close monitoring is highly recommended.
Highlights
Anaplastic thyroid carcinoma (ATC) accounts for only 1–2% of thyroid cancer but contributes to more than 50% of thyroid cancer-related mortalities [1]
A retrospective study composed of 23 Japanese patients with ATC treated with lenvatinib showed an incidence of 39.1%
To minimize risks of rapid tumor shrinkage leading to adverse effect (AE), we suggest a reduced dose or frequency of lenvatinib such as 10 milligrams every other day be used in high-risk patients
Summary
Anaplastic thyroid carcinoma (ATC) accounts for only 1–2% of thyroid cancer but contributes to more than 50% of thyroid cancer-related mortalities [1]. Lenvatinib, an oral multi-targeted tyrosine kinase inhibitor (TKI), was approved as treatment of locally advanced or recurrent, radioactive iodine (RAI) refractory differentiated thyroid cancer (DTC) [2]. It has been approved as a treatment for ATC in Japan. A retrospective study composed of 23 Japanese patients with ATC treated with lenvatinib showed an incidence of 39.1%. Similar clinical data is relatively scarce, especially in non-Japanese patients with ATC. We report two cases with stage IVc ATC who received lenvatinib treatment. Both patients initially had bulky tumor with tracheal compression and distant metastasis. Lenvatinib led to massive tumor necrosis and shrinkage, it resulted in significant morbidities, including tracheal perforation and fistula formation
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