The Effect of Lenvatinib and Pembrolizumab on Thyroid Cancer Refractory to Iodine 131i Simulated by Mathematical Modeling

Abstract

Immunotherapy and targeted therapy are alternative treatments to differentiated thyroid cancer (DTC), which is usually treated with surgery and radioactive iodine. However, in advanced thyroid carcinomas, molecular alterations can cause a progressive loss of iodine sensitivity, thereby making cancer resistant to radioactive iodine-refractory (RAIR). In the treatment of cancer, tyrosine kinase inhibitors are administered to prevent the growth of cancer cells. One such inhibitor, lenvatinib, forms a targeted therapy for RAIR-DTC, while the immunotherapeutic pembrolizumab, a humanized antibody, prevents the binding of programmed cell death ligand 1 (PD-L1) to the PD-1 receptor. As one of the first studies on treatments for thyroid cancer with mathematical model involving immunotherapy and targeted therapy, we developed an ordinary differential system and tested variables such as concentration of lenvatinib and pembrolizumab, total cancer cells, and number of immune cells (i.e., T cells and natural killer cells). Analyzing local and global stability and the simulated action of drugs in patients with RAIR-DTC, revealed the combined effect of the targeted therapy with pembrolizumab. The scenarios obtained favor the combined therapy as the best treatment option, given its unrivaled ability to boost the immune system’s rate of eliminating tumor cells.