Tyrosine Kinase Inhibitors for the Treatment of Advanced Thyroid Carcinoma: Real-Life Monocentric Experience

  • PURPOSE: To report the efficacy and toxicity of TKIs treatment in real-life practice. METHODS: Eighteen patients on Lenvatinib (n=12, 7 F, mean age 51 years) and Vandetanib (n=6, 3 F, mean age 41 years) in a single Center, with an average follow-up of 17.6 and 46.3 months, respectively. Response to treatment defined using the RECIST criteria. Adverse events assessed using the CTCAE 4.03 scale. RESULTS: At the last follow up visit, progression-free survival is 22.1 and 51 months for Lenvatinib and Vandetanib, respectively. The best morphological response with Lenvatinib is a partial response (PR) in 9/12 and a stable disease (SD) in 3/12 patients; with Vandetanib, a PR in 3/6, a SD in 2/6 and a disease progression in 1/6 patients. During the follow up, the frequency of dose reduction, temporary discontinuation, or definitive withdrawal has been of 57%, 43%, and 0% with Lenvatinib and of 50%, 0% and 0% with Vandetanib. Frequent shared adverse events were hyperthension (86% and 50% of patients on Lenvatinib and Vandetanib, respectively), diarrhea (85% of patients), treated with Loperamide; asthenia (85%), primary hypoadrenalism (39%); weight loss (69%) and anorexia (62%). Prolongation of the QT interval and rash were present in 50% of patients on Vandetanib. CONCLUSIONS: Treatment with Lenvatinib and Vandetanib is effective, but hampered by a high rate of adverse events. The good therapeutic response and the low rate of dosage reduction or treatment discontinuation was achieved thanks to a close monitoring and careful management of adverse events by a multidisciplinary team.

 

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