Treatment with tyroisine kinase inhibitor in thyroid cancer: A single centre experience

Diana Catarino; Cristina Ribeiro; Joana Saraiva; Miguel Melo; Lucia Fadiga; Diana Silva; Joana Guiomar; Mariana Lavrador; Inês Vieira; Sara Ferreira; Cátia Araújo; Bárbara Araújo; Isabel Paiva

doi:10.1530/endoabs.70.EP482

Introduction: Tyrosine kinase inhibitors (TKI) demonstrated clinically significant activity in radio iodine (RAI)-refractory differentiated thyroid cancer (DTC) and in locally recurrent, unresectable and metastatic medullary thyroid cancer (MTC). The natural history of MTC and DCT is quite variable with rates of disease progression ranging from a few months to many years. TKI can be associated with progression-free survival, but is not curative and the side effects may have a significant effect on patient’ quality of life.

Objective: Characterization of patients with thyroid carcinoma treated with TKI, followed at the endocrine department of a hospital centre, between 2001 and 2019.

Methods: Retrospective cohort study, based on clinical records of patients with DTC and MTC treated with TKI. Statistical analyses with SPSS.

Results/Conclusion: We obtained 14 patients: 71.4% (n = 10) female, mean age at the diagnosis: 45.93 ± 13.56 years. 35.7% (n = 5) papillary carcinoma, 35.7% (n = 5) follicular carcinoma and 28.6% (n = 4) medullary carcinoma. One patient with MTC had a genetic confirmation of MEN2. All patients performed total thyroidectomy at diagnosis, five of them performed lymph nodes resection too. Three patients had distant metastases at diagnosis. All patients with DTC (n = 10) underwent RAI-therapy (cumulative mean dose: 566.4 ± 354.6 mCi). These patients had disease progression with metastases (cervical lymph nodes: n = 7; distant lymph nodes: n = 4; pulmonary: n = 7; cerebral: n = 2; bone: n = 2), a median of thyroglobulin-721 ng/l (reference range:1.6–60) and non-radioiodine avid disease. It was decided to perform TKI therapy: sorafenib in 9 patients (800 mg/day) and lenvatinib in 1 patient (24 mg/day). Four patients died due to disease progression; five patients performed a second TKI therapy-lenvatinib [4 dues to disease progression (mean Tg:698 >3682.7 ng/l) and 1 due to side effects of sorafenib], one patient maintains the initial TKI with stable disease. Actually, four patients with DTC are alive, three of them with stable disease. Relative to patients with MTC (n = 4), it was decided to perform ITK Therapy due to disease progression, namely the presence of metastases (absence at diagnosis): cervical lymph node: n = 3; distant lymph node: n = 2; pulmonary: n = 2; liver: n = 1; bone- n = 1). Three patients perform therapy with vandetanib (300 mg/day) and one with sorafenib (800 mg/day). Three patients are actually alive.

Side effects of TKI were frequent, mainly gastrointestinal (anorexia-47%; transaminases’ elevation-37%, diarrhea-32%), hypertension-47% and dermatologic effects 37%; needing dose reduction (36.8%) or even therapy suspension (10.5%). Optimal management of side effects is essential because they have a significant effect on quality of life and this should be factored into treatment decisions.

Endocrine Abstracts

EP482