Spotlight on lenvatinib in the treatment of thyroid cancer

Patient selection and perspectives

Ricardo Costa, Benedito A Carneiro Filho, Sunandana Chandra, Sachin G. Pai, Young Kwang Chae, Jason B Kaplan, Hannah B. Garrett, Mark Agulnik, Peter Andreas Kopp, Francis Joseph Giles

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)873-884
Number of pages12
JournalDrug Design, Development and Therapy
Volume10
DOIs
StatePublished - Feb 29 2016

Fingerprint

Thyroid Neoplasms
Patient Selection
Iodine
Salvage Therapy
Therapeutics
Protein-Tyrosine Kinases
Disease-Free Survival
lenvatinib
Drug Therapy
United States Food and Drug Administration
Placebos
Confidence Intervals
Incidence

Keywords

  • Differentiated thyroid cancer
  • Lenvatinib
  • Targeted therapy
  • Thyroid cancer
  • Tyrosine kinse inhibitor

ASJC Scopus subject areas

  • Pharmacology
  • Pharmaceutical Science
  • Drug Discovery

Cite this

Costa, Ricardo ; Carneiro Filho, Benedito A ; Chandra, Sunandana ; Pai, Sachin G. ; Chae, Young Kwang ; Kaplan, Jason B ; Garrett, Hannah B. ; Agulnik, Mark ; Kopp, Peter Andreas ; Giles, Francis Joseph. / Spotlight on lenvatinib in the treatment of thyroid cancer : Patient selection and perspectives. In: Drug Design, Development and Therapy. 2016 ; Vol. 10. pp. 873-884.
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Spotlight on lenvatinib in the treatment of thyroid cancer : Patient selection and perspectives. / Costa, Ricardo; Carneiro Filho, Benedito A; Chandra, Sunandana; Pai, Sachin G.; Chae, Young Kwang; Kaplan, Jason B; Garrett, Hannah B.; Agulnik, Mark; Kopp, Peter Andreas; Giles, Francis Joseph.

In: Drug Design, Development and Therapy, Vol. 10, 29.02.2016, p. 873-884.

Research output: Contribution to journalReview article

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T1 - Spotlight on lenvatinib in the treatment of thyroid cancer

T2 - Patient selection and perspectives

AU - Costa, Ricardo

AU - Carneiro Filho, Benedito A

AU - Chandra, Sunandana

AU - Pai, Sachin G.

AU - Chae, Young Kwang

AU - Kaplan, Jason B

AU - Garrett, Hannah B.

AU - Agulnik, Mark

AU - Kopp, Peter Andreas

AU - Giles, Francis Joseph

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N2 - 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.

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KW - Targeted therapy

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U2 - 10.2147/DDDT.S93459

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