Endocrine Abstracts

Background: Lenvatinib is an oral chemotherapy for metastatic radioiodine-refractory differentiated thyroid cancer (RRDTC) which significantly improves progression free survival (PFS). It has been proved that higher rates of dose interruption or reduction of Lenvatinib have a negative impact on PFS. Patients with active cancer, such as RRDTC, have an increased risk of contracting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and developing complications, especially in case of lung involvement. It is necessary to evaluate a safe continuation of anti-cancer treatment during infections and intercurrent illness.

Case Presentation: A 74-year-old male patient was treated with Lenvatinib (18 mg/day) for advanced RRDTC (recurrence in the thyroid bed and multiple lung metastases) since March 2019. He showed partial response to treatment, with a progressive reduction of metastases. In September 2020, the patient tested positive for SARS-CoV2. After a few days, he developed mild symptoms (cough, diarrhea and asthenia). We decided not to discontinue Lenvatinib treatment and to monitorate vital signs in telemedicine daily. After 21 days, the patient tested negative for SARSCoV2 and he experienced no severe respiratory, gastrointestinal or hematologic complications.

Conclusions: Patients with cancer usually have comorbidities, with an increased risk for COVID-19 morbidity and mortality. Continuing Lenvatinib should be favoured, if possible according to the clinical setting. Careful monitoring of both COVID19 symptoms and anticancer adverse events are important for assessing treatment continuation. As data is limited, this report is an important indicator of the safety of continuing Lenvatinib treatment during the SarsCov2 infection and could be more widely generalized for other oncologic patients with COVID19. Studies with larger samples and longer follow up are required to determine the safety of continuing anti-cancer treatment during COVID19.