Maegawa Yuka, Higashiguchi Takashi, Futamura Akihiko, Tsuzuki Norimasa, Murai Miyo
Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan.
Department of Surgery and Palliative Medicine, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Fujita Med J. 2019;5(1):25-29. doi: 10.20407/fmj.2018-003. Epub 2018 Dec 6.
Management of anaplastic thyroid cancer (ATC) is often difficult because of its aggressive characteristics. Molecular-targeted therapy was recently introduced as an alternative therapeutic strategy for ATC; lenvatinib is a molecular-targeted agent that is currently indicated only in Japan for the treatment of ATC. Here we report the case of an 86-year-old Japanese woman with ATC who was treated with lenvatinib at our hospital and exhibited a remarkable response. Computed tomography showed tumor shrinkage by day 8 and stable disease until day 32. She maintained activities of daily living (ADLs) until shortly before her death. The patient's resting energy expenditure and body composition were analyzed at the time of admission. Potential toxicity risk of lenvatinib was evaluated based on these data. Enteral nutrition for oral intake was supplied to compensate for her lack of dietary intake and to improve metabolism for the purpose of suppressing lenvatinib toxicity. She also engaged in physical rehabilitation to avoid developing sarcopenia, which is thought to be a risk factor of molecular-targeted therapy toxicity, and to maintain her activity level. We emphasize the importance of a team approach for providing an appropriate treatment regimen to maintain ADLs, which includes nutritional support, physical rehabilitation, and aggressive therapy with lenvatinib.
间变性甲状腺癌（ATC）因其侵袭性特征，治疗往往颇具难度。分子靶向治疗作为ATC的一种替代治疗策略，近期被引入；乐伐替尼是一种分子靶向药物，目前仅在日本被批准用于治疗ATC。在此，我们报告一例86岁日本女性ATC患者，在我院接受乐伐替尼治疗后出现显著反应。计算机断层扫描显示，第8天时肿瘤缩小，至第32天病情稳定。她直至临终前不久仍能维持日常生活活动（ADL）。入院时对患者的静息能量消耗和身体成分进行了分析。基于这些数据评估了乐伐替尼的潜在毒性风险。为弥补其饮食摄入不足并改善代谢以抑制乐伐替尼毒性，提供了肠内营养以补充经口摄入。她还进行了身体康复训练，以避免发生肌肉减少症（这被认为是分子靶向治疗毒性的一个危险因素）并维持其活动水平。我们强调采用团队协作方法提供适当治疗方案以维持ADL的重要性，这包括营养支持、身体康复训练以及使用乐伐替尼进行积极治疗。
