Rapid pleural effusion after discontinuation of lenvatinib in a patient with pleural metastasis from thyroid cancer

Abstract

Summary We report a case of rapid pleural effusion after discontinuation of lenvatinib. A 73-year-old woman was diagnosed with poorly differentiated thyroid cancer with right pleural metastasis. Weekly paclitaxel treatment was performed for 18 weeks, but it was not effective. Oral administration of lenvatinib, a multi-target tyrosine kinase inhibitor, reduced the size of cervical and thoracic tumors and lowered serum thyroglobulin levels. Lenvatinib was discontinued on day 28 because of Grade 2 thrombocytopenia and Grade 3 petechiae. Seven days after discontinuation of lenvatinib, the patient was hospitalized because of dyspnea and right pleural effusion. Pleural effusion rapidly improved with drainage and re-initiation of lenvatinib and did not recur. Anorexia caused by lenvatinib led to undernutrition, which resulted in death 13 months after initiation of lenvatinib. Autopsy revealed extensive necrosis with primary and metastatic lesions, suggesting that the patient responded to lenvatinib. Physicians should be aware of the possibility of flare-up in patients with thyroid cancer treated with lenvatinib. Learning points: Autopsy findings revealed that lenvatinib was efficacious in treating poorly differentiated thyroid cancer without primary lesion resection. Flare-up phenomenon may occur in thyroid cancer treated with lenvatinib. Attention should be paid to flare-up phenomenon within a few days of discontinuing lenvatinib.

Pleural fluid due to papillary thyroid cancer

“…However, as this is a rare condition, standard therapy has not yet established. This case report documents our clinical experience, we present herein a patient with pleural fluid due to papillary thyroid cancer, and reviewed previously reported such cases (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…Massive pleural fluid caused by thyroid cancer is very rare. To our best knowledge, there have been reported only 51 cases (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). According to a review by Vassilopoulou-Sellin and Sneige at the MD Anderson Cancer Center, 10 (0.6%) had malignant pleural fluid that developed during the course of the disease among 1772 differentiated papillary thyroid cancer patients (4).…”

“…The articles detected are shown in References (Reference no. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Fifty-one patients of pleural fluid due to thyroid cancer were confirmed.…”

“…Lung metastases of thyroid cancer are those to the lung parenchyma, such metastases usually have multiple small nodules in both lungs (1,2). On the contrary, however, pleural fluid due to thyroid cancer is a rare etiology, to our knowledge, and only 51 cases have been reported (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Pleural fluid due to thyroid cancer has been reported to be less than 1% in all the patients with malignant pleural fluids (4,11).…”

“…Papillary thyroid cancer was the major histologic type of thyroid cancer with pleural effusion, and other histologic types were few (3). Thyroid cancer patients with pleural fluid, regardless of tissue type, were long-term survivors (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In general, diagnosis of malignant fluid is established by positive pathological findings using specimens from pleural fluid (20).…”