ETA2024 Poster Presentations Thyroid cancer treatment (10 abstracts)
Can nocturnal administration of lenvatinib based on time pharmacology reduce adverse events?
Akifumi Suzuki 1 , Kiminori Sugino 2 , Ryoji Ohara 3 , Yoko Kuga 3 , Ai Matsui 3 , Kana Yoshioka 3 , Yoshiyuki Saito 3 , Chie Masaki 3 , Junko Akaishi 3 , Kiyomi Hames 3 , Ritsuko Okamura 3 , Chisato Tomoda 4 , Kenichi Matsuzu 3 , Wataru KItagawa 3 , Mitsuji Nagahama 4 & Koichi Ito 3
1Ito Hospital, Ito Hospital, Surgery, Tokyo, Japan; 2Ito Hospital, Surgery, Tokyo; 3Ito Hospital, Surgery; 4Ito Hospital
Purpose: Molecularly targeted drugs are indispensable therapeutic tools for the treatment of unresectable differentiated thyroid cancer. Lenvatinib (LEN) is listed as a preferred regimen in the NCCN guidelines, and is a highly effective anti-tumor agent, but is also associated with a high rate of adverse events (AEs), which may be related to prognosis. AE management is key to LEN therapy. Although there is no recommendation in the package insert regarding the recommended time of LEN administration, A woman in her 30s with lung metastasis of poorly differentiated thyroid cancer who was attending our hospital was accidentally changed to take LEN "before sleep" instead of "after lunch", and her hand-foot syndrome (HFS) and diarrhea of AE were clearly reduced. HFS is said to be aggravated by loading of palms and soles and drug secretion from eccrine sweat glands, and it was assumed that the decrease in LEN blood concentration during the daytime (when palms and soles are loaded) due to pre-sleep medication was a factor in the improvement of HFS. Later, a woman in her 60s who had been suffering from HFS changed the time of her medication to "before sleep," and her HFS decreased as well. We hypothesized that LEN nighttime administration may reduce AEs from a time pharmacological perspective, and examined our patient’s case.
Methods: A retrospective study of 44 patients with thyroid differentiated carcinoma of the thyroid, out of 107 patients who received LEN from 1/1/2015 to 9/30/2023, who changed the time of oral administration.
Results: The time of oral administration was changed a total of 55 times. The change to after breakfast, lunch, dinner, and before sleep was 16/5/18/16 times each. 62% (34/55) of the patients changed the time to nighttime, including after dinner and before sleep. The reason for changing the time of administration was to reduce AEs in 25 cases (28 times (1/3/12/12 times after breakfast/lunch/dinner/before sleep), of which 21 times (75%) AEs were reduced. The most common reasons for change in AEs were HFS/fatigue/diarrhea in 12/11/5 cases, and AEs could be reduced only by changing the time of administration in 4/4/3 cases (33/36/60%), respectively. In particular, the diarrhea was thought to be due to the fact that taking LEN at night, when DNA synthesis in the gastrointestinal mucosa is decreased, reduced the damage to normal cells.
Conclusion: Changing the time of LEN administration to nighttime may reduce AEs such as HFS and diarrhea.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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