Lenvatinib for the Treatment of Radioiodine-Refractory Thyroid Cancer in Real-Life Practice

Berdelou, A.; Borget, Isabelle; Godbert, Yann; Nguyen, Thierry; Garcia, Marie-Eve; Chougnet, C.; Ferru, Aurélie; Buffet, C; Chabre, Olivier; Huillard, Olivier; Leboulleux, Sophie; Schlumberger, Martin; Netwo, on the behalf of the TUTHYREF

doi:10.1089/thy.2017.0205

Cited by 95 publications

(79 citation statements)

References 12 publications

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“…Other differences in the selection criteria apply as a result of the nature of retrospective studies, such as ECOG-PS 0-2, which independently reviewed radiologic evidence of progression within the previous 13 months. Several studies have evaluated the real-world clinical outcomes of lenvatinib for treating patients with RAI-r DTC in Europe , sunitinib (n = 10), vandetinib (n = 8), paclitaxel (n = 7), axitinib (n = 6), dabrafenib/trametinib combination (n = 5), and pembrolizumab (n = 2) [16][17][18][19]. Most of these studies concluded that there was a real-world clinical benefit of using lenvatinib to treat patients with RAI-r DTC in four European countries.…”

Section: Discussionmentioning

confidence: 99%

Lenvatinib and Subsequent Therapy for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Real-World Study of Clinical Effectiveness in the United States

et al. 2020

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Introduction: Lenvatinib has become the most commonly prescribed first-line (1L) agent for the treatment of radioactive iodine-refractory differentiated thyroid cancer (RAI-r DTC) since its approval in 2015. With no real-world studies describing clinical outcomes of 1L lenvatinib and subsequent therapy, the current study aimed to assess treatment sequencing and related clinical outcomes in patients treated with 1L lenvatinib in the USA Methods: We conducted a multisite, retrospective chart review of US patients with a diagnosis of RAI-r DTC who had initiated 1L therapy with lenvatinib from January 1, 2016 through May 31, 2017 with follow-up through October 17, 2018. Physicians completed electronic case report forms for two patient cohorts: patients still receiving 1L lenvatinib (cohort 1) and those who had initiated second-line (2L) therapy prior to data cutoff (cohort 2). Real-world objective response rate (ORR) was assessed for both cohorts. Progression-free survival (PFS) and overall survival (OS) were assessed for cohort 2. Results: A total of 252 patients met the study criteria with 71 in cohort 1 and 181 in cohort 2. Patients were predominantly female, had papillary DTC, and had lung metastases. The ORR was 64.8% for cohort 1 and 53.6% for cohort 2. In cohort 2, median PFS from 1L lenvatinib initiation was 14.0 months (95% CI 12.7-15.0). Second-line treatments included sorafenib (49.7%), cabozantinib (19.3%), and other targeted/chemotherapy/immuno-oncology agents. The ORR in 2L therapy was 15.5%. For cohort 2, the 12-, 18-, and 24-month OS from initiation of 1L lenvatinib was 92.8%, 81.5%, and 66.9%, respectively. Conclusions: In this first real-world examination of clinical effectiveness of 1L lenvatinib and subsequent therapy among patients in the US, the results demonstrated that treatment with 1L lenvatinib followed by another 2L therapy may deliver a clinical benefit, thus allowing a number of potential 2L options following 1L lenvatinib for patients with RAI-r DTC.

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Section: Discussionmentioning

confidence: 99%

Lenvatinib and Subsequent Therapy for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Real-World Study of Clinical Effectiveness in the United States

et al. 2020

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“…EBRT, embolisation, percutaneous treatment modalities) can be done for local control, without discontinuing MKIs [V, C]. Data on real life experiences with lenvatinib in DTC patients are now available and as expected, the drug's efficacy was not as good as that observed in highly selected RCT populations [100,101]. Other antiangiogenic agents have been tested as first-line therapy in phase II trials, with widely varying response rates ( [81,111].…”

Section: Management Of Advanced/metastatic Diseasementioning

confidence: 99%

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

et al. 2019

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“…Additionally, over the last decades, several new drugs and new methods of targeted therapy have been launched ( 12 ). A study conducted in France reported 75 patients with advanced radioactive iodine-refractory DTC could benefit from Lenvatinib with a median progression-free survival of 10 months ( 39 ), and this drug was recently approved by the U.S. Food and Drug Administration. More attention should be paid to targeted therapy with the better understanding of risk stratification of TC for precise treatment.…”

Section: Discussionmentioning

confidence: 99%

The Increased Risk of Thyroid Cancer-Specific Mortality With Tumor Size in Stage IVB Patients

Zhang

Cheng

et al. 2020

Front. Oncol.

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Purpose: To investigate the risk-stratifying utility of tumor size and a threshold for further stratification on cancer-specific mortality of thyroid cancer (TC) patients in stage IVB. Methods: One thousand three hundred and forty-five patients (620 males and 725 females) with initial distant metastasis over 55 years between 2004 and 2016 from Surveillance, Epidemiology, and End Results databases were investigated, with a median follow-up time of 23 months [interquartile range (IQR), 5-56 months] and a median age of 70 years (IQR, 63-77 years). TC-specific mortality rates were calculated under different classifications. Cox regressions were used to calculate hazard ratios (HRs) and Kaplan-Meier Analyses were conducted to investigate TC-specific survivals. Results: In the whole cohort, patients with tumors >4 cm had the highest TC-specific mortality (67.9%, 330/486), followed by tumor size >1 cm but ≤4 cm (43.08%, 190/441), and tumor size ≤1 cm (32.69%, 34/104). Kaplan-Meier curves showed the increased tumor size was associated with a statistically significant decrease in TC-specific survival (P < 0.001). Papillary thyroid cancer (PTC) patients with tumors >4 cm had significantly higher hazard ratios (HRs) of 2.84 (1.72-4.70) and 3.11 (1.84-5.26) after adjusting age, gender, race, and radiation treatment, compared with patients with tumors ≤1 cm (P < 0.001). The TC-specific mortalities and survivals were further investigated among more detailed subgroups divided by different tumor size, and a threshold of 3 cm could be observed (P < 0.005) for risk stratification. Conclusions: Mortality risk increased with tumor size in PTC patients in stage IVB. Our findings demonstrated the possibility of further stratification in IVB stage in current TNM staging system. Patients with tumor size over 3 cm had an excessively high risk of PTC-specific mortality, which may justify the necessity of more aggressive treatment for them.

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Lenvatinib for the Treatment of Radioiodine-Refractory Thyroid Cancer in Real-Life Practice

Abstract: Real-life patients with rDTC can benefit from lenvatinib treatment. AEs are frequent and should be closely monitored.

Cited by 95 publications

References 12 publications

Lenvatinib and Subsequent Therapy for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Real-World Study of Clinical Effectiveness in the United States

Lenvatinib and Subsequent Therapy for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Real-World Study of Clinical Effectiveness in the United States

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

The Increased Risk of Thyroid Cancer-Specific Mortality With Tumor Size in Stage IVB Patients

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