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(searched for: RAI Refractory Differentiated Thyroid Cancer Treated with Lenvatinib: Case Report)
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Noelia Vanesa Dujovne, Natalia Gazek, Fabian Pitoia, Victor Ayarzabal, Maria Belen Lucero, Laura Felipe, Marta Ciaccio, Jessica Lopez Marti, Viviana Herzovich
Journal of the Endocrine Society, Volume 4; doi:10.1210/jendso/bvaa046.121

Abstract:
Introduction: Papillary thyroid cancer (PTC) is the most common thyroid tumor in childhood. Most patients are referred with locally advanced and/or distant disease at the time of diagnosis. Whenever possible, these patients should be offered total thyroidectomy and radioiodine remnant ablation; however, this approach is not always feasible, rendering these tumors unresectable. These critical cases could benefit from neoadjuvant treatment with multikinase inhibitors (MKI) so that standard treatment can be performed. Lenvatinib is an MKI recently approved in many countries throughout the world for the treatment of radioiodine refractory adult differentiated thyroid cancer. Only few pediatric cases have been reported. Case report: A 10-year-old female patient with locally advanced PTC and metastasis to the lungs, who required 3 liters of oxygen due to respiratory failure caused by bilateral miliary lung disease, mistakenly treated as tuberculosis two months previously and referred to our Hospital. A large thyroid mass adhered to deep tissues was confirmed on CT scan, showing a large heterogeneous neck mass with multiple microcalcifications associated with multiple lymph nodes. Both lungs had multiple micro-nodular disease with interstitial involvement. Total thyroidectomy together with lymph-node dissection was planned, but extensive local infiltration made the lesion unresectable and surgery was limited to a thyroid biopsy. The patient required respiratory assistance. Histopathology confirmed the presence of a PTC (diffuse sclerosing variant) with a RET-PTC3 oncogene rearrangement. Eight days after surgery the patient was critical and we decided to indicate the compassionate use of Lenvatinib. The patient was started on oral lenvatinib at a dose of 14 mg daily (14 mg/m/day). Three days later, she clinically improved and nine days post-lenvatinib initiation, the patient was discharged from hospital without need for oxygen therapy. Lab studies showed a rise in thyroglobulin levels in the first month of treatment followed by a significant drop. All Lung Function Test parameters significantly improved. The patient initially had severe restrictive breathing and due to the resting dyspnea with hypoxemia she could not perform the walking test. Two months after treatment onset she could walk 360 meters in six minutes with 96% oxygen saturation. After 4 months on Lenvatinib, imaging studies showed a stable thyroid mass while the pulmonary nodules appeared stable to slightly smaller without evidence of new or progressive disease. Conclusion: On lenvatinib treatment, our patient showed significant clinical improvement, arrest of disease progression, and stable disease on imaging studies. This case shows that lenvatinib may be a beneficial option for children with advanced PTC not amenable to surgery/RAI treatment and may be used as a bridge to these first-line therapies.
Alice Nervo, Alberto Ragni, Marco Gallo, Andrea Ferraris, Paolo Fonio, Alessandro Piovesan, Emanuela Arvat
Published: 1 February 2020
Thyroid, Volume 30, pp 229-236; doi:10.1089/thy.2019.0355

The publisher has not yet granted permission to display this abstract.
Ivana Puliafito, Caterina Puglisi, Stefania Marchisotta, Pasquale Malandrino, Paolo Giuffrida, Francesca Esposito, Angela Prestifilippo, Dario Giuffrida
Journal of Cancer Science and Clinical Therapeutics, Volume 4, pp 229-236; doi:10.26502/jcsct.5079067

Abstract:
Background: Differentiated thyroid carcinoma (DTC) is the most common malignant tumor of the thyroid gland and causes local and/or distant metastases. Differentiated thyroid carcinoma (DTC) is the most common form, representing more than 90% of all thyroid cancers and derives from the follicular cells of the thyroid. Choroidal metastasis from DTC is extremely rare. Only a few cases have been reported in literature. Case Summary: We report the case of a 43-year-old man with differentiated thyroid cancer. He underwent a total thyroidectomy plus a right latero-cervical lymphoadenectomy. Histological examination revealed a 7 mm papillary thyroid cancer, pT3N1b. Firstly treated with locoregional treatment. In February 2012 computer tomography (CT) scan and WBS showed a progression of disease with bilateral lung lesions, bilateral multiple jugular carotid lymphnodes and bone metastases localized in the IV thoracic rib. After progression disease he was treated with Lenvatinib 24 mg daily. Symptomatic choroid metastases were diagnosed 4 years after initial diagnosis, and were treated with external-beam radiation. Although treatment reduced local masses, a rapid progression of multiple metastatic lesions was observed. Conclusion: In our case, progression free survival with lenvatinib was in agreement with data of SELECT trial, this is a rare case of choroidal metastases from DTC.
BMC Cancer, Volume 18; doi:10.1186/s12885-018-4612-2

Abstract:
The advent of tyrosine kinase inhibitors (TKIs) has changed the treatment of RAI refractory, unresectable recurrent differentiated thyroid cancer (DTC), which was formerly treated with multidisciplinary remedies. Here we describe the case of a 64-year-old woman who underwent total thyroidectomy with tracheal resection and suffered from a recurrent tumor in the neck and multiple lung and bone metastases 3 and 11 months, respectively, after the operation. Multimodal therapies, RI (I-131), EBRT, and taxane-based chemotherapy were ineffective, and sorafenib was started as a TKI. However, because of disease progression, sorafenib was replaced by lenvatinib after 9 months. The effect of lenvatinib has continued for more than 1 year and 9 months, and the patient has well survived. During the treatment period, a tracheal pin-hole fistula suddenly emerged, which was naturally cured by the temporary cessation of lenvatinib. Adverse events such as hypertension, proteinuria, and diabetes as innate complications have been successfully managed until the present according to our institute regulations. Even where multimodal treatment was ineffective, lenvatinib was suggested to be an alternative treatment option for RAI refractory recurrent DTC and patient could have a chance to be controlled successfully.
Sciprofile linkFrancesco Felicetti, Sciprofile linkAlice Nervo, Alessandro Piovesan, Rita Berardelli, Filippo Marchisio, Sciprofile linkMarco Gallo, Sciprofile linkEmanuela Arvat
Expert Review of Anticancer Therapy, Volume 17, pp 1093-1098; doi:10.1080/14737140.2017.1390432

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Sciprofile linkDavid Viola, Laura Valerio, Eleonora Molinaro, Laura Agate, Valeria Bottici, Agnese Biagini, Loredana Lorusso, Virginia Cappagli, Letizia Pieruzzi, Carlotta Giani, et al.
Published: 1 April 2016
Endocrine-Related Cancer, Volume 23; doi:10.1530/erc-15-0555

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