Spotlight on lenvatinib in the treatment of thyroid cancer: patient selection and perspectives
Open Access
- 1 February 2016
- journal article
- review article
- Published by Taylor & Francis Ltd in Drug Design, Development and Therapy
- Vol. ume 10, 873-884
- https://doi.org/10.2147/DDDT.S93459
Abstract
Spotlight on lenvatinib in the treatment of thyroid cancer: patient selection and perspectives Ricardo Costa,1 Benedito A Carneiro,1,2 Sunandana Chandra,1,2 Sachin G Pai,1 Young Kwang Chae,1,2 Jason B Kaplan,1,2 Hannah B Garrett,1 Mark Agulnik,1,2 Peter A Kopp,3 Francis J Giles1,2 1Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, 2Division of Hematology and Oncology, Feinberg School of Medicine, 3Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Thyroid cancer is the most common endocrine malignancy, with over 60,000 cases reported per year in the US alone. The incidence of thyroid cancer has increased in the last several years. Patients with metastatic differentiated thyroid cancer (DTC) generally have a good prognosis. Metastatic DTC can often be treated in a targeted manner with radioactive iodine, but the ability to accumulate iodine is lost with decreasing differentiation. Until recently, chemotherapy was the only treatment in patients with advanced thyroid cancer, which is no longer amenable to therapy with radioactive iodine. The modest efficacy and significant toxicity of chemotherapy necessitated the need for urgent advances in the medical field. New insights in thyroid cancer biology propelled the development of targeted therapies for this disease, including the tyrosine kinase inhibitor sorafenib as salvage treatment for DTC. In 2015, the US Food and Drug Administration approved a second tyrosine kinase inhibitor, lenvatinib, for the treatment of radioiodine-refractory thyroid cancer. Although associated with a significant progression-free survival improvement as compared to placebo in a large Phase III study (median progression-free survival 18.2 vs 3.6 months; hazard ratio 0.21; 99% confidence interval 0.14–0.31; P<0.001), the benefit of lenvatinib needs to be proved in the context of associated moderate to severe toxicities that require frequent dose reduction and delays. This article reviews the evidence supporting the use of lenvatinib as salvage therapy for radioactive iodine-refractory thyroid cancer, with a focus on the toxicity profile of this new therapy. Keywords: lenvatinib, thyroid cancer, targeted therapy, differentiated thyroid cancer, tyrosine kinse inhibitorKeywords
This publication has 100 references indexed in Scilit:
- Worldwide Increasing Incidence of Thyroid Cancer: Update on Epidemiology and Risk FactorsJournal of Cancer Epidemiology, 2013
- Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trialThe Lancet Oncology, 2012
- A phase I study of E7080, a multitargeted tyrosine kinase inhibitor, in patients with advanced solid tumoursBritish Journal of Cancer, 2012
- Pertuzumab plus Trastuzumab plus Docetaxel for Metastatic Breast CancerThe New England Journal of Medicine, 2012
- Single nucleotide polymorphisms and mRNA expression of VEGF-A in papillary thyroid carcinoma: Potential markers for aggressive phenotypesEuropean Journal of Surgical Oncology, 2011
- Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium studyThe Lancet Oncology, 2010
- Clinical efficacy of a RAF inhibitor needs broad target blockade in BRAF-mutant melanomaNature, 2010
- Increased Expression of Vascular Endothelial Growth Factor and Its Receptors, VEGFR-1 and VEGFR-2, in Medullary Thyroid CarcinomaThyroid®, 2010
- Erlotinib at a Dose of 25 mg Daily for Non-small Cell Lung Cancers with EGFR MutationsJournal of Thoracic Oncology, 2010
- The biology of VEGF and its receptorsNature Medicine, 2003