Future OncologyVol. 15, No. 24s SupplementFree AccessLenvatinib in differentiated thyroid carcinoma: the Italian experienceAlessandro PiovesanAlessandro Piovesan*Author for correspondence: E-mail Address: apiovesan@cittadellasalute.to.itOncological Endocrinology Unit, Città della Salute e della Scienza Hospital, Turin, ItalySearch for more papers by this authorPublished Online:6 Aug 2019https://doi.org/10.2217/fon-2019-0179AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail Keywords: case reportdifferentiated thyroid cancerlenvatinibtreatmentDifferentiated thyroid carcinoma (DTC) shows an increasing incidence worldwide [1–3]. The standard treatment for this condition is represented by surgery, followed by radioactive iodine (RAI) administration if necessary and levothyroxine therapy [4,5]. RAI can further be administered to treat persistent disease, local recurrences and distant metastases. However, a significant proportion of DTC patients ultimately becomes refractory to RAI [4,5] or a too high cumulative dose of I131 is reached. Until a few years ago, treatment options in this population were limited by poor efficacy and tolerability.Several molecular pathways are involved in the development of DTC, including rearrangements of RET/PTC oncogenes, alterations of the BRAF, NRAS and HRAS pathways and altered interplay of EGF/VEGF receptor and EGF/EGF receptors. All these pathways play a key role in tumor progression and invasiveness [6], and can be targeted by specific therapeutic agents. On these bases, multitargeted tyrosine kinase inhibitors, including sorafenib and lenvatinib, have been largely investigated for the treatment of DTC [5].In particular, lenvatinib is an oral inhibitor of VEGFR1–3, FGFR1–4, PDGFRα, RET and KIT, which showed activity in several types of cancer [5,7]. In the pivotal Phase III SELECT trial, lenvatinib significantly prolonged progression-free survival (18.3 vs 3.6 months; p < 0.001) and increased overall response rate (64.8 vs 1.5%) compared with placebo in 392 patients with advanced RAI-resistant DTC [8]. A difference in overall survival was not reported in this trial; however, this was likely due to permitting crossover to lenvatinib after progression in the placebo group [5,8] Moreover, in a subsequent subanalysis of the SELECT data, a prolonged survival was evident in older patients treated with lenvatinib [9]. Based on the favorable results of the SELECT trial, lenvatinib has been approved for the treatment of locally recurrent or metastatic, progressive, RAI-refractory DTC.‘Field practice’ experience on lenvatinib is still scant [10], and reporting interesting experiences on the use of this molecule in daily practice and in peculiar clinical cases can be of the highest interest, in order to investigate issues not usually addressed in pivotal trials and to gain knowledge on the potential toxicities of this molecule [5,11,12].Therefore, we have decided to develop this Supplement, which reports relevant clinical cases from Italian experts in the use of lenvatinib. Moreover, Gay et al. documented the use of lenvatinib in neoadjuvant setting in a patient affected by invasive poorly DTC; La Torre et al. reported on the use of lenvatinib in a patient with cardiological comorbidities – a relevant issue, since hypertension was frequently reported in the SELECT trial [8]. On a similar note, Marina et al. investigated QT-corrected prolongation in a lenvatinib recipient. In their paper, Porcelli et al. describe the management of a patient who developed oligoprogression during treatment with lenvatinib. Sperone et al. present a case of long-term disease control and high clinical benefit in a patient with advanced DTC. Last, Simontacchi et al. describe the excellent clinical and radiological response to lenvatinib and ablative stereotactic radiotherapy.We do hope that these experiences can represent the first step toward a more generalized collection of case reports and observational ‘field-practice’ analyses on the use of lenvatinib in DTC, in order to further clarify and expand on the use of this molecule.DisclaimerThe supporting company was not offered the opportunity to revise the manuscript and had no role in the decision to submit.Financial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Medical writing support was provided by L Giacomelli and A Shah of Polistudium (Milan, Italy), on behalf of Content Ed Net and were funded for their assistance by Eisai.