Scheduled cessation in treatment using lenvatinib for differentiated thyroid carcinoma

Abstract

Abstract Backgrounds Recently, multi-targeted tyrosine kinase inhibitors(m-TKIs) have become a treatment strategy for radioactive iodine-refractory differentiated thyroid carcinoma (RR-DTC).m-TKIs often require dose reduction or cessation due to various adverse events (AEs). Moreover, these AEs often lose the motivation of patients for the continuation of treatment. We therefore tried scheduled cessation of lenvatinib (LEN) to avoid or reduce AEs during the course of long-term administration. Methods We tried scheduled cessation for five of 20 DTC patients who started LEN administration between Jul. 2015 and Oct. 2017. These five patients experienced intolerable toxicities resulting in frequent interruptions and dose reductions of LEN before introduction of scheduled cessation. Results All were females and aged 66-83 years. Two patients underwent LEN administration of 8 mg/day for two weeks and cessation for one week. Others underwent LEN administration of 10 mg/day for three weeks and cessation for one week, of 10-14 mg/day for two weeks and cessation for one week, and of 10 mg/day for two weeks and cessation for one week. Direct reasons for introduction of scheduled cessation were fatigue and anorexia for three patients, hand-foot-syndrome for one patient, and proteinuria for one patient, respectively. With a median follow-up period of 26.7 months, no patients showed further deterioration of AEs, enabling all patients to continue LEN in these schedules. One patient showed progression of metastatic lesions, but the remaining four patients achieved stable disease during these periods. Conclusions Scheduled cessation can relieve AEs of patients, and may be considered as an effective strategy to continue treatment of LEN with maintaining the motivation of patients.