Lenvatinib-induced thyroid abnormalities in unresectable hepatocellular carcinoma

Area of Science:

• Oncology
• Endocrinology
• Pharmacology

Background:

• Lenvatinib demonstrates anti-tumor activity in advanced hepatocellular carcinoma (HCC).
• Thyroid dysfunction, particularly hypothyroidism, is a known complication of lenvatinib therapy.
• Limited data exists on lenvatinib-induced thyroid toxicity and destructive thyroiditis.

Purpose of the Study:

• To determine the frequency and timing of thyroid abnormalities in patients with unresectable HCC receiving lenvatinib.
• To evaluate risk factors associated with lenvatinib-induced hypothyroidism or thyrotoxicosis.
• To explore the relationship between thyroid dysfunction and patient prognosis.

Main Methods:

• Retrospective study of 50 patients with advanced HCC treated with lenvatinib.
• Classification of patients into euthyroid, subclinical hypothyroidism, overt hypothyroidism, and thyrotoxicosis groups.
• Assessment of the timing of thyroid dysfunction onset and evaluation of risk factors using multivariate models.

Main Results:

• Hypothyroidism occurred in 66% of patients (subclinical 14%, overt 52%), with 84.4% developing it within 2 weeks of lenvatinib initiation.
• Thyrotoxicosis occurred in 10% of patients, with some cases developing within 1-8 weeks of treatment.
• No correlation was found between autoantibodies and the incidence or severity of thyroid dysfunction.
• Progression-free survival was significantly better in patients with hypothyroidism.

Conclusions:

• Lenvatinib treatment for unresectable HCC frequently induces hypothyroidism and thyrotoxicosis, often within the early treatment period.
• Patients experiencing lenvatinib-induced thyroid dysfunction demonstrated a better prognosis.
• Close monitoring for thyroid dysfunction is crucial from the initiation of lenvatinib therapy.