Nephrotoxicity in advanced thyroid cancer treated with tyrosine kinase inhibitors: An update

Nervo, Alice; Retta, Francesca; Ragni, Alberto; Piovesan, Alessandro; Mella, Alberto; Biancone, Luigi; Manganaro, Marco; Gallo, Marco; Arvat, Emanuela

doi:10.1016/j.critrevonc.2021.103533

Cited by 10 publications

(7 citation statements)

References 87 publications

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“…Although the majority of our patients also developed proteinuria during LEN treatment, no correlation was found between its grade and that of HTN, confirming that the mechanisms by which MKI induce HTN and proteinuria are different, as hypothesised in a recent review which evaluated literature data regarding MKIs treatment and nephrotoxicity (35). Moreover, it is interesting to note that patients with or without pre-existing HTN or any other cardiovascular disease (including myocardial infarction, valvulopathies) had a similar incidence of HTN during LEN, confirming that the underlying mechanisms are probably related exclusively to the anti-angiogenic drug.…”

Section: Discussionsupporting

confidence: 82%

Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm

Colombo

Ceruti

Leo

et al. 2023

European Thyroid Journal

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Background: Hypertension (HTN) is the most frequent adverse event during treatment with Lenvatinib (LEN), but data on its best management are limited. Aim: To assess incidence, features and best management of LEN-related HTN in a consecutive single tertiary-care Centre cohort. Methods: 29 patients followed for a mean time of 29.8 months (6-77 months). Results: After a mean follow-up of 6.8 months, HTN was recorded in 76% of cases, as a de novo occurrence in half of them. HTN significantly correlated with LEN dose, and was of grade 1, grade 2 and grade 3 in 5%, 50% and 45% of patients, respectively. The majority (77%) of patients with HTN developed proteinuria. There was no correlation between HTN and either proteinuria or clinical features or best morphological response or any other AE, with the exception of diarrhoea. Patients with or without pre-existing HTN or any other cardiovascular disease had a similar incidence of HTN during LEN, thus excluding the impact of this potential predisposing factor. After evaluation by a dedicated cardiologist, medical treatment was introduced in 21/22 patients (polytherapy in 20 of them). The most frequently used drugs were calcium channel blockers (CCB) due to their effect on vasodilation. In case of poor control, CCB were associated with one or more anti-hypertensive drug. Conclusion: HTN is a frequent and early adverse event in patients on LEN treatment. We suggest a diagnostic-therapeutic algorithm to be applied in clinical practice to allow efficient HTN control and improve patient compliance, reducing LEN discontinuation.

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Section: Discussionsupporting

confidence: 82%

Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm

Colombo

Ceruti

Leo

et al. 2023

European Thyroid Journal

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“…In our cohort, hepatocellular carcinoma was presented in eight (57.1%) patients using various antineoplastic treatments, including tyrosine kinase inhibitor, platinum, and radiotherapy. The nephrotoxicity of antineoplastic agents has been reported in recent years [15][16][17][18], but the histopathological evidence has been limited, especially in patients after liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Renal histopathological lesions after liver transplantation: What can we find besides calcineurin inhibitor-induced nephrotoxicity?

et al. 2022

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Background Chronic kidney disease (CKD) is a common complication after liver transplantation and is traditionally considered to be secondary to calcineurin inhibitors (CNIs). However, several studies have reported that the etiology of CKD after liver transplantation is broad and may only be assessed accurately by renal biopsy. The current study aimed to explore the usefulness of renal biopsies in managing CKD after liver transplantation in daily clinical practice. Method This retrospective analysis enrolled all post-liver transplantation patients who had a renal biopsy in a single center from July 2018 to February 2021. Results Fourteen renal biopsies were retrieved for review from 14 patients at a median of 35.7 (minimum-maximum: 2.80–134.73) months following liver transplantation. The male-to-female ratio was 13:1 (age range, 31–75 years). The histomorphological alterations were varied. The predominant glomerular histomorphological changes included focal segmental glomerular sclerosis (FSGS) (n = 4), diabetic glomerulopathy (n = 4), and membranoproliferative glomerulonephritis (n = 4). Thirteen (92.9%) patients had renal arteriolar sclerosis. Immune complex nephritis was present in six patients, of whom only two had abnormal serum immunological indicators. Despite interstitial fibrosis and tubular atrophy being present in all the patients, only six (42.9%) presented with severe interstitial injury. No major renal biopsy-related complications occurred. After a mean follow-up of 11.8 months (range: 1.2–29.8), three patients progressed to end-stage renal disease (ESRD). Conclusion The etiology of CKD after liver transplantation might be more complex than originally thought and should not be diagnosed simply as calcineurin inhibitors(CNI)-related nephropathy. Renal biopsy plays a potentially important role in the diagnosis and treatment of CKD after liver transplantation and might not be fully substituted by urine or blood tests. It may help avoid unnecessary changes to the immunosuppressants and inadequate treatment of primary diseases.

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“…It is authorized for the treatment of advanced differentiated thyroid carcinoma. Another TKI for advanced thyroid cancer patients is sorafenib, which inhibits PDGFR, RAF, and VEGFR ( 101 ). TKIs are frequently used when traditional therapies such as surgery or radioactive iodine are inadequate, or when advanced thyroid cancer cannot be physically removed ( 101 ).…”

Section: Advances In Targeted Therapy Of Thyroid Cancermentioning

confidence: 99%

“…Another TKI for advanced thyroid cancer patients is sorafenib, which inhibits PDGFR, RAF, and VEGFR ( 101 ). TKIs are frequently used when traditional therapies such as surgery or radioactive iodine are inadequate, or when advanced thyroid cancer cannot be physically removed ( 101 ). They are especially beneficial for aggressive thyroid tumors that have progressed outside the thyroid gland.…”

Section: Advances In Targeted Therapy Of Thyroid Cancermentioning

confidence: 99%

Advances in targeted therapy and biomarker research in thyroid cancer

Guo,

Sun,

Wei

et al. 2024

Front. Endocrinol.

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Driven by the intricacy of the illness and the need for individualized treatments, targeted therapy and biomarker research in thyroid cancer represent an important frontier in oncology. The variety of genetic changes associated with thyroid cancer demand more investigation to elucidate molecular details. This research is clinically significant since it can be used to develop customized treatment plans. A more focused approach is provided by targeted therapies, which target certain molecular targets such as mutant BRAF or RET proteins. This strategy minimizes collateral harm to healthy tissues and may also reduce adverse effects. Simultaneously, patient categorization based on molecular profiles is made possible by biomarker exploration, which allows for customized therapy regimens and maximizes therapeutic results. The benefits of targeted therapy and biomarker research go beyond their immediate clinical impact to encompass the whole cancer landscape. Comprehending the genetic underpinnings of thyroid cancer facilitates the creation of novel treatments that specifically target aberrant molecules. This advances the treatment of thyroid cancer and advances precision medicine, paving the way for the treatment of other cancers. Taken simply, more study on thyroid cancer is promising for better patient care. The concepts discovered during this investigation have the potential to completely transform the way that care is provided, bringing in a new era of personalized, precision medicine. This paradigm shift could improve the prognosis and quality of life for individuals with thyroid cancer and act as an inspiration for advances in other cancer types.

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Nephrotoxicity in advanced thyroid cancer treated with tyrosine kinase inhibitors: An update

Cited by 10 publications

References 87 publications

Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm

Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm

Renal histopathological lesions after liver transplantation: What can we find besides calcineurin inhibitor-induced nephrotoxicity?

Advances in targeted therapy and biomarker research in thyroid cancer

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