Medical Oncology Department and Thyroïd and Endocrine Tumors Department, Groupe de Recherche Clinique n°16, GRC Tumeurs Thyroïdiennes, APHP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.
Nephrology Department, APHP Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France.
Expert Opin Drug Saf. 2022 Nov;21(11):1401-1410. doi: 10.1080/14740338.2022.2153115. Epub 2022 Dec 7.
Multi-receptor tyrosine kinase inhibitors with anti-angiogenic activity, particularly lenvatinib, have become the standard treatment for radioiodine-refractory metastatic differentiated thyroid cancer but are associated with a high incidence of toxicity. Although patients treated with lenvatinib have been shown to have a significant improvement in progression-free survival, lenvatinib-associated toxicity may result in dose reductions, dose interruptions or even complete lenvatinib withdrawal, compromising anti-tumor efficacy.
The article covers the main cardiological and renal toxicities of lenvatinib, including hypertension, prolonged QT interval, heart failure, arterial and venous thromboembolic events, proteinuria and renal failure, and proposes appropriate management of these events during lenvatinib therapy. We performed a literature review of cardiovascular and renal toxicities of Lenvatinib in radioiodine-refractory differentiated thyroid cancer. We discussed prophylactic and therapeutic management for each toxicity based on literature and clinical expertise.
Specific pre-therapeutic evaluation and close monitoring of patients treated with lenvatinib is necessary to prevent and detect cardiovascular and/or renal toxicities early, and to propose appropriate management. Oncologists who treat patients with lenvatinib should know how to monitor and treat these adverse events, and when to ask for the advice of a specialist (cardiologist or nephrologist).
具有抗血管生成活性的多受体酪氨酸激酶抑制剂，特别是仑伐替尼，已成为治疗放射性碘难治性转移性分化型甲状腺癌的标准治疗方法，但与高发生率的毒性相关。尽管接受仑伐替尼治疗的患者在无进展生存期方面有显著改善，但仑伐替尼相关的毒性可能导致剂量减少、剂量中断甚至完全停止仑伐替尼治疗，从而影响抗肿瘤疗效。
本文涵盖了仑伐替尼的主要心脏毒性和肾脏毒性，包括高血压、QT 间期延长、心力衰竭、动脉和静脉血栓栓塞事件、蛋白尿和肾衰竭，并提出了在仑伐替尼治疗期间对这些事件进行适当管理的建议。我们对放射性碘难治性分化型甲状腺癌中仑伐替尼的心血管和肾脏毒性进行了文献回顾。我们根据文献和临床专业知识讨论了每种毒性的预防和治疗管理。
对接受仑伐替尼治疗的患者进行特定的治疗前评估和密切监测是必要的，以预防和早期发现心血管和/或肾脏毒性，并提出适当的管理建议。治疗接受仑伐替尼治疗的患者的肿瘤学家应该知道如何监测和治疗这些不良事件，以及何时需要咨询专家（心脏病专家或肾病专家）的建议。
