Paschke L, Lincke T, Mühlberg K, Lindner Tom H, Paschke R
Division of Endocrinology, Department of Endocrinology and Nephrology, University Clinic Leipzig, Germany.
Division of Nuclear Medicine, Department of Radiology, University Clinic Leipzig, Germany.
Case Rep Endocrinol. 2019 Jun 10;2019:7927450. doi: 10.1155/2019/7927450. eCollection 2019.
TKIs including anti-VEGF receptor activity have been approved for the treatment of patients with radioiodine resistant thyroid carcinomas. For lenvatinib arterial thromboembolic events are listed as adverse events of special interest with lenvatinib. In the phase III study, arterial thromboembolic events were reported in 3% of lenvatinib-treated patients and 1% in the placebo group. Most of the patients had predisposing factors. Only one myocardial infarct was reported in the lenvatinib phase III study. We report a 73-year-old female patient with metastatic thyroid papillary carcinoma who was treated with total thyroidectomy. The operation was followed by four radioiodine therapies over a period of 6 years. At 6 years she developed lung metastasis without radioiodine uptake, one solitary liver metastasis and one solitary right renal metastasis. One year after the first diagnosis of radioiodine resistant lung metastasis the lung metastasis showed progression according to RECIST criteria. This treatment was resulting in prolonged partial response with disappearance of a hepatic and renal metastasis. A myocardial infarction occurred after 39 months of lenvatinib treatment resulting in implantation of 3 stents and a two chamber pacemaker. The treatment was discontinued. Except for well controlled hypertension there were neither predisposing diseases like diabetes nor symptoms of cardiac ischemia on exertion. However, the family history for cardiovascular diseases was positive for cardiac infarction reported for one brother. Another brother was treated for hypertension and the patient's mother suffered from a cerebral infarction at the age of 60. While only one myocardial infarct was reported in the lenvatinib phase III study with 392 patients this case suggests that long-term treatment with lenvatinib may be associated with an increased risk for myocardial infarct also in patients with no predisposing diseases except well controlled hypertension and positive family history for cardiovascular diseases.
包括具有抗血管内皮生长因子受体活性的酪氨酸激酶抑制剂（TKIs）已被批准用于治疗放射性碘难治性甲状腺癌患者。对于乐伐替尼，动脉血栓栓塞事件被列为特别关注的不良事件。在III期研究中，3%接受乐伐替尼治疗的患者报告发生动脉血栓栓塞事件，而安慰剂组为1%。大多数患者有诱发因素。乐伐替尼III期研究中仅报告了1例心肌梗死。我们报告1例73岁女性转移性甲状腺乳头状癌患者，接受了甲状腺全切术。术后6年进行了4次放射性碘治疗。6年后，她出现无放射性碘摄取的肺转移、1个孤立性肝转移和1个孤立性右肾转移。在首次诊断放射性碘难治性肺转移1年后，根据实体瘤疗效评价标准（RECIST），肺转移出现进展。该治疗使肝转移和肾转移消失，获得了延长的部分缓解。乐伐替尼治疗39个月后发生心肌梗死，导致植入3个支架和1个双腔起搏器。治疗中断。除高血压控制良好外，既没有糖尿病等诱发疾病，也没有运动时心脏缺血的症状。然而，心血管疾病家族史阳性，1个兄弟有心肌梗死报告。另1个兄弟患有高血压，患者母亲60岁时患脑梗死。虽然乐伐替尼III期研究中392例患者仅报告了1例心肌梗死，但该病例表明，对于除高血压控制良好和心血管疾病家族史阳性外无诱发疾病的患者，长期使用乐伐替尼可能也会增加心肌梗死风险。
