Damásio Inês L, Figueiredo Ana, Maciel Joana, Horta Mariana, Silva Tiago N, Simões-Pereira Joana, Donato Sara, Leite Valeriano
Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal -
Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal.
Minerva Endocrinol (Torino). 2024 Mar 21. doi: 10.23736/S2724-6507.23.03982-9.
Treatment of advanced differentiated thyroid carcinoma (DTC) remains a challenge as 25-50% of patients with locally invasive or distant metastatic disease become refractory to radioiodine (RAI) therapy. Tyrosine kinase inhibitors (TKI) are increasingly used in this setting. The SELECT trial demonstrated that lenvatinib, a multikinase inhibitor, significantly improved progression free survival (PFS) compared to placebo. Our aim was to report the effectiveness and safety of lenvatinib in our series of patients with advanced DTC.
A total of 25 patients with advanced DTC followed at a single tertiary center from January of 2016 to January of 2022 were retrospectively reviewed.
Patients were treated with a mean daily dose of lenvatinib of 16.9 mg for a mean of 9.1 months. Median estimated PFS was 31.3 months. One patient achieved complete response. The objective response rate (ORR) was 40% and the disease control rate was 84%. The mean change in summed longest diameter of target lesions from baseline to nadir was -36.9%. Lenvatinib prolonged the tumor volume doubling time in 86.7% patients. Interestingly, we found that patients treated with a lower dose of lenvatinib (<16.9 mg daily) had a significantly higher PFS and ORR than patients treated with higher dosages (>16.9 mg). Adverse events were frequently reported.
Our results confirm the effectiveness of lenvatinib in the management of patients with advanced DTC and support the need to adjust the dosage of lenvatinib to patient´s performance status and comorbidities.
晚期分化型甲状腺癌（DTC）的治疗仍然是一项挑战，因为25%-50%的局部侵袭性或远处转移性疾病患者对放射性碘（RAI）治疗变得难治。酪氨酸激酶抑制剂（TKI）在这种情况下越来越多地被使用。SELECT试验表明，多激酶抑制剂乐伐替尼与安慰剂相比，显著改善了无进展生存期（PFS）。我们的目的是报告乐伐替尼在我们一系列晚期DTC患者中的有效性和安全性。
回顾性分析了2016年1月至2022年1月在单一三级中心随访的25例晚期DTC患者。
患者接受乐伐替尼治疗，平均每日剂量为16.9mg，平均治疗9.1个月。估计中位PFS为31.3个月。1例患者达到完全缓解。客观缓解率（ORR）为40%，疾病控制率为84%。目标病灶最长直径总和从基线到最低点的平均变化为-36.9%。乐伐替尼使86.7%的患者肿瘤体积倍增时间延长。有趣的是，我们发现接受较低剂量乐伐替尼（<16.9mg/天）治疗的患者的PFS和ORR显著高于接受较高剂量（>16.9mg）治疗的患者。不良事件报告频繁。
我们的结果证实了乐伐替尼在晚期DTC患者管理中的有效性，并支持根据患者的体能状态和合并症调整乐伐替尼剂量的必要性。
