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1 . Table 1 Clinical and pathological data of two groups of patients with advanced thyroid cancer treated with sorafenib and lenvatinib, respectively. Data are presented as n (%), mean ± s.d. or as median (IQR). Variables
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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function evaluation in 36 patients receiving TKIs treatment for advanced thyroid cancer. All patients ( n = 36) Lenvatinib ( n = 25) Vandetanib ( n = 6) Selpercatinib ( n = 5) Patients who developed fatigue 31/36, 86% 23
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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patients with advanced thyroid cancer on LEN treatment, a 76% incidence of HTN was recorded with a mean onset of 6.8 months (range 1–32 months) after the start of treatment. These data are in accordance with the average HTN incidence of 72.4% reported in
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NOVA Medical School
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episodes of active bleeding in the scalp during a follow-up of 10 months (Fig. 2 c). Discussion and Conclusion ECT was successfully used to treat bleeding scalp metastases in this patient who had advanced thyroid cancer and serious comorbidities
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Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Introduction: Lenvatinib (LEN) is a multitarget tyrosine kinase inhibitor currently used for advanced, radioiodine refractory differentiated thyroid cancer (RAI-R DTC). Among adverse events (AEs), nausea, vomiting, and decreased appetite have been frequently described. We aimed to evaluate the prevalence, the clinical presentation, and the effectiveness of conservative treatment of gallbladder disorders in a consecutive series of patient treated with LEN. Methods: Patients with RAI-R DTC experiencing clinical symptoms suggestive for gallbladder disorders during LEN treatment were evaluated with laboratory investigations and contrast-enhanced abdominal computed tomography (CT) and ultrasound scan (US). Results: After a median time of 2 months from the start of treatment, 5/13 patients (38.4%) complained of gastrointestinal symptoms, with increased biliary enzymes levels, especially γGT, and CT/US suggestive of acute cholecystitis (AC). The onset of symptoms and the peak of γGT levels frequently corresponded to the highest reduction in body weight during the first months of treatment. All patients were treated with supportive care and, when appropriate, with ursodeoxycholic acid; in 4 patients, LEN dose reduction or short interruption was needed, too. Conclusions: In patients with RAI-R DTC treated with LEN, a high prevalence of AC in the first months of treatment was documented. Mainly due to the low specificity of symptoms such as anorexia, nausea, and vomiting, this AE is likely to be frequently misdiagnosed. The onset of the disease was associated to the weight loss observed during the first months of treatment and contributes to further decrease in body weight. Therefore, particularly during the first months of treatment, or at any time of huge reduction of body weight, monitoring of γGT and US is crucial for prompt diagnosis and treatment. Conservative medical treatment and LEN dosage titration, together with dietary and rehabilitative supports, can limit or avoid the need for drug withdrawal and cholecystectomy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Premise Few prospective studies are available on the management of patients with advanced thyroid cancer (TC), and the decision making is mostly based on the personal experience of physicians. The present guidelines are mainly based on the
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Introduction Advances in molecular genotyping with high-throughput sequencing have led to better understanding of the genetic landscape of thyroid cancer and ultimately to major improvements in the treatment of advanced thyroid cancers ( 1
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Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Weight loss is one of the most frequent adverse events during treatment with multikinase inhibitors, but scanty data are available on its extent and characteristics. This is the first assessment of the body composition by bioelectrical impedance analysis and of circulating leptin and ghrelin levels, in patients with advanced thyroid cancer before and at regular intervals during treatment with the tyrosine kinase inhibitor lenvatinib. Body mass index (BMI) decreased in all patients, with an average ∆ reduction of –6.4, –9.8, and –15.3% at 3, 6, and 12 months of treatment, respectively. Interestingly, in most patients, after the first year of treatment, BMI remained stable. In all patients, fat mass (FM) reduced more than fat-free mass, the highest decrement being of –60 and –16%, respectively. A decrease in the body cell mass, a parameter mainly due to muscle tissue, was observed only in patients with a vast baseline muscular mass. Total body water decreased in parallel to BMI. During treatment, leptin tightly paralleled the decrease of BMI values, consistent with the decrease in FM, whereas ghrelin levels increased upon BMI decrease. The loss of the FM accounts for the largest portion of BMI reduction during lenvatinib treatment. The increase in ghrelin could account for the BMI stabilization observed after 1 year of treatment. Nevertheless, oral nutritional supplements should be given as early as possible and athletic patients should be encouraged to maintain physical activity. In some circumstances, parenteral nutrition is required for the rehabilitation of these patients.
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Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
Nova Medical School: Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
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advanced thyroid cancer that is unresponsive to MKIs. Further studies are needed to understand the specific role of GEMOX chemotherapy in RAIR thyroid carcinomas and the impact of the associated molecular profiles. Declaration of interest The
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RK Leboeuf R Sherman EJ Pfister DG Deandreis D Pentlow KS Zanzonico PB Haque S Gavane S , et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer . New England Journal of Medicine 2013 368 623 – 632 . ( https
