Keywords
Thyroid Cancer
Papillary
Tyrosine Kinase Inhibitors
Dosage
Maximum tolerated dose
Case Reports
How to Cite
Abstract
Background: Lenvatinib belongs to the pharmacological group of tyrosine kinase inhibitors and was approved in 2015 for the treatment of locally advanced or metastatic progressive thyroid cancer that is refractory to iodine-131 (I-131) therapy.
Purpose: To present a stepwise reintroduction of lenvatinib for metastatic radioiodine-refractory thyroid cancer, after discontinuation due to a serious adverse event, achieving a favorable radiologic response with a lower-than-usually-recommended dose.
Case presentation: A 65-year-old woman with a diagnosis of metastatic papillary thyroid cancer, refractory to iodine, who required a change in therapy to Lenvatinib due to intolerance to sorafenib. Although she initially received the usual starting doses, the treatment was suspended due to a severe adverse effect. It was later restarted in a stepwise manner, leading to a partial imaging response a year and a half after reaching the maximum tolerated dose.
Discussion: The adverse effects of Lenvatinib often require temporary suspension or dose reduction. Various studies have demonstrated a dose-dependent relationship between clinical outcomes and adverse events.
Conclusion: There is no consensus on how to restart or titrate Lenvatinib doses after an adverse effect. However, it is essential that this process be individualized and managed by a multidisciplinary team, considering the risks and benefits to achieve the maximum tolerated dose.
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