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Thrombotic microangiopathy associated with lenvatinib therapy
Macarena Contreras Angulo1, Belén García Izquierdo1, Laura Armengod Grao1
1Department of Endocrinology and Nutrition, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
Endocrine Oncology (Bristol, England)
|July 12, 2023
Summary
Systemic thrombotic microangiopathy (TMA) is a serious condition. Lenvatinib, a cancer drug, has been linked to TMA, even with systemic involvement, which is described here for the first time.
Area of Science:
- Oncology
- Nephrology
- Hematology
Background:
- Systemic thrombotic microangiopathy (TMA) is a critical condition requiring prompt treatment.
- Tyrosine kinase inhibitors, such as lenvatinib used for advanced cancers, are associated with TMA, primarily renal forms.
- Systemic TMA involving multiple organs due to lenvatinib has not been previously documented.
Observation:
- A patient with metastatic thyroid cancer developed systemic TMA after initiating lenvatinib therapy.
- The case highlights the clinical presentation, diagnostic process, and successful treatment of this rare complication.
- This presentation underscores the potential for lenvatinib to induce TMA beyond renal involvement.
Findings:
- Lenvatinib can precipitate a predominantly systemic form of TMA, characterized by hemolytic anemia, thrombocytopenia, and organ damage.
- Distinguishing lenvatinib-induced TMA from primary forms is crucial and can be aided by ADAMTS-13 testing.
- Early recognition through peripheral blood smear analysis in patients with anemia and thrombocytopenia on lenvatinib is recommended.
Implications:
- This case expands the known spectrum of lenvatinib-associated TMA.
- It emphasizes the importance of vigilant monitoring for systemic TMA in patients treated with lenvatinib.
- Prompt drug discontinuation and supportive care are vital for managing this potentially life-threatening condition.
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