Molecular-targeted therapy for advanced anaplastic thyroid cancer combined with nutritional support

Management of anaplastic thyroid cancer (ATC) is often difficult because of its aggressive characteristics. Molecular-targeted therapy was recently introduced as an alternative therapeutic strategy for ATC; lenvatinib is a molecular-targeted agent that is currently indicated only in Japan for the treatment of ATC. Here we report the case of an 86-year-old Japanese woman with ATC who was treated with lenvatinib at our hospital and exhibited a remarkable response. Computed tomography showed tumor shrinkage by day 8 and stable disease until day 32. She maintained activities of daily living (ADLs) until shortly before her death. The patient's resting energy expenditure and body composition were analyzed at the time of admission. Potential toxicity risk of lenvatinib was evaluated based on these data. Enteral nutrition for oral intake was supplied to compensate for her lack of dietary intake and to improve metabolism for the purpose of suppressing lenvatinib toxicity. She also engaged in physical rehabilitation to avoid developing sarcopenia, which is thought to be a risk factor of molecular-targeted therapy toxicity, and to maintain her activity level. We emphasize the importance of a team approach for providing an appropriate treatment regimen to maintain ADLs, which includes nutritional support, physical rehabilitation, and aggressive therapy with lenvatinib.