Myocardial Infarction after Long-Term Treatment with a Tyrosine Kinase Inhibitor (TKI) with Anti-VEGF Receptor...

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• Thyroid carcinomas resistant to radioiodine treatment can be managed with tyrosine kinase inhibitors (TKIs) like lenvatinib.
• Arterial thromboembolic events are identified as adverse events of special interest for lenvatinib therapy.

Observation:

• A 73-year-old patient with metastatic papillary thyroid carcinoma developed radioiodine-refractory lung, liver, and renal metastases.
• After 39 months of lenvatinib treatment for progressive metastatic disease, the patient experienced a myocardial infarction, requiring stent implantation and pacemaker insertion.

Findings:

• The myocardial infarction occurred despite the patient having only well-controlled hypertension and a family history of cardiovascular disease, with no other significant predisposing factors.
• This contrasts with the lenvatinib phase III study, which reported only one myocardial infarction among 392 patients.

Implications:

• This case suggests a potential association between long-term lenvatinib use and an increased risk of myocardial infarction, particularly in patients with a positive family history of cardiovascular disease.
• Further investigation into the long-term cardiovascular safety profile of lenvatinib in thyroid cancer patients is warranted.