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Efficacy of lenvatinib in treating thyroid cancer
Jolanta Krajewska1, Aleksandra Kukulska1, Barbara Jarzab1
1a Nuclear Medicine and Endocrine Oncology Department , M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Gliwice , Poland.
Introduction:
Radioiodine [RAI]-resistant advanced and progressive differentiated thyroid cancer [DTC], although rare, constitutes a real challenge as its prognosis is poor and available therapeutic options, until now, have been limited. Discovery of a crucial role of distinct tyrosine kinases in DTC pathogenesis opened up new options in systemic treatment. Lenvatinib is an oral potent multi kinase inhibitor [MKI] of different growth factor receptors including VEGFR1/Flt-1, VEGFR2/KDR, VEGFR3, FGFR1,2,3,4, PDGFR-β as well as RET and KIT signaling networks. Its activity against RAI-refractory DTC was demonstrated in clinical studies fulfilling evidence-based medicine [EBM] criteria. The drug showed acceptable tolerance and manageable toxicity.
Areas Covered:
published results of phase II and III studies and other reports evaluated the efficacy and safety of lenvatinib in DTC and in medullary thyroid carcinoma.
Expert Opinion:
Currently there are two different MKIs, lenvatinib and sorafenib, which have demonstrated effectiveness against RAI-refractory DTC. However, to date, the question of which drug should be chosen for first line treatment remains open. The other question: when to start the treatment seems to be no less important. Whether disease progression, even by RECIST, is enough to initiate a therapy or tumor burden also plays an important role? EBM study, to resolve these issues, is our task for the nearest future.
Insights
Lenvatinib shows efficacy and manageable toxicity in radioiodine-refractory differentiated thyroid cancer. Further evidence-based medicine studies are needed to determine optimal first-line treatment strategies and timing for advanced thyroid cancer.
Area of Science:
- Oncology
- Pharmacology
Background:
- Radioiodine-refractory differentiated thyroid cancer (DTC) presents a poor prognosis with limited therapeutic options.
- Tyrosine kinase inhibitors offer new systemic treatment avenues for DTC.
- Lenvatinib, a multi-kinase inhibitor, targets key signaling pathways implicated in DTC pathogenesis.
Purpose of the Study:
- To evaluate the efficacy and safety of lenvatinib in patients with advanced and progressive differentiated thyroid cancer.
- To review clinical studies assessing lenvatinib's activity in RAI-refractory DTC.
Main Methods:
- Analysis of published phase II and III studies.
- Review of other reports on lenvatinib's efficacy and safety in DTC and medullary thyroid carcinoma.
Main Results:
- Lenvatinib demonstrated acceptable tolerance and manageable toxicity in clinical studies.
- Evidence-based medicine criteria support lenvatinib's activity against RAI-refractory DTC.
Conclusions:
- Lenvatinib and sorafenib are effective multi-kinase inhibitors for RAI-refractory DTC.
- Optimal first-line treatment selection and treatment initiation timing for RAI-refractory DTC require further investigation through evidence-based medicine studies.
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