Late renal toxicity in patient with radioiodine-refractory differentiated thyroid cancer treated with lenvatinib: A case report and literature review

Abstract

Introduction Thyroid carcinoma is the most common endocrine neoplasm. Multimodal therapy including surgery, radioactive iodine (RAI) therapy, and indefinite suppression of thyroid-stimulating hormone has led to an 85% cure rate in differentiated thyroid tumors (DTT). Approximately 5–10% of patients will have recurrence or metastases that have the potential to become resistant to RAI treatment. 1 10-year overall survival rates are reported to be 10% in these patients versus 56% in patients with RAI avid disease. 2 Lenvatinib, a multi-tyrosine-kinase inhibitor (TKI), was shown to have a 65% overall response rate in addition to a significant improvement in progression-free survival (PFS), approved to treat RAI-resistant DTTs. 3 , 4 Case Report We are reporting a very rare case of late renal toxicity in a 68-year-old woman with a history of type 2 diabetes and metastatic RAI-resistant follicular thyroid carcinoma (Hurthle cell variant) who developed thrombotic microangiopathy 21 months after initiation of treatment. Management & Outcome It was determined that LEN should be held, due to worsening renal function secondary to TKI-induced kidney injury. Although the patient's renal function eventually improved and returned to her baseline after discontinuation of LEN, there was marked disease progression after drug cessation. Discussion Renal toxicity is a rare adverse event (AE) that tends to occur typically within three weeks of initiation of treatment. The utilization of TKIs can lead to glomerulosclerosis, and careful considerations and precautions should be taken by clinicians who intend to initiate TKI therapy in patients with pre-existing diabetes to prevent renal toxicity.

Cardiovascular Implications of Cumulative Radioiodine Doses in Patients With Differentiated Thyroid Cancer and Type 2 Diabetes Mellitus, Bihar, India: A Retrospective Study.

“…Another investigation delved into the inflammatory response to radioiodine therapy in women, revealing that the interplay between neutrophils and obesity might limit 131I uptake, suggesting a complex association between prescribed radioiodine activity, blood radioactivity, BMI, and inflammatory markers in patients with both DTC and T2DM [9]. Further research explored the role of peripheral circulating free DNA and the platelet-to-lymphocyte ratio in individuals undergoing radioiodine therapy, indicating potential biomarkers for assessing therapy outcomes in this unique cohort [10]. Additionally, a case report and literature review on late renal toxicity in patients treated with lenvatinib for radioiodine-refractory DTC highlighted the importance of cautious treatment initiation in people with pre-existing diabetes to prevent renal toxicity, suggesting an intricate balance between effective cancer treatment and the management of comorbid conditions [11].…”