Adverse Effects of Tyrosine Kinase Inhibitors – Real World Use

  • Background
    Kinase inhibitors are recommended for treating radioactive iodine (RAI)-refractory differentiated thyroid cancer patients that is not otherwise amenable to local control using alternative approaches. Although associated with a significant progression-free survival improvement as compared to placebo in a large Phase III study, the benefit of TKIs needs to be proved in the context of associated moderate to severe toxicities that require frequent dose reduction and delays.
     
    Methods
    Retrospective cohort study of medical records of 71 patients treated with tyrosine kinase inhibitors lenvatinib and sorafenib for thyroid cancer at Gangnam Severance Hospital from July 2016 to December 2017 was conducted. Baseline clinical parameters, dosage and adverse effects from initiation of treatment were collected.
     
    Results
    As tyrosine kinase inhibitors, sorafenib (N=48) and lenvatinib (N=23) was used. Adverse effects occurred in 19 patients (82.6%), requiring dose reduction in 8 (34.8%) of patients and drug cessation in 1 patient (4.3%). For patients using sorafenib, the initial starting dose was £400mg daily in 12 patients (25.0%), 600mg in 16 patients (33.3%) and 800mg daily in 20 patients (41.7%). Dose reduction was needed for adverse effects in 27 patients (56.3%), and drug cessation was necessary in 4 patients (8.3%). When most common adverse effect was compared between sorafenib and lenvatinib, hand-foot-syndrome was significantly more frequent in patient using sorafenib (42 (87.5%) vs 13 (56.2%), p=0.003).
     
    Discussion & Conclusion
    Both of the TKIs showed high rate of adverse effect. Adverse effect was more observed in sorafenib patients, which needed more often drug cessation.

 

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