Clinical factors related to the efficacy of tyrosine kinase inhibitor therapy in radioactive iodine refractory recurrent differentiated thyroid cancer patients

Kiminori Sugino; Mitsuji Nagahama; Wataru Kitagawa; Keiko Ohkuwa; Takashi Uruno; Kenichi Matsuzu; Akifumi Suzuki; Chie Masaki; Junko Akaishi; Kiyomi Y. Hames; Chisato Tomoda; Yuna Ogimi; Koichi Ito

doi:10.1507/endocrj.EJ17-0365

ORIGINAL

Clinical factors related to the efficacy of tyrosine kinase inhibitor therapy in radioactive iodine refractory recurrent differentiated thyroid cancer patients

Kiminori Sugino, Mitsuji Nagahama, Wataru Kitagawa, Keiko Ohkuwa, Takashi Uruno, Kenichi Matsuzu, Akifumi Suzuki, Chie Masaki, Junko Akaishi, Kiyomi Y. Hames, Chisato Tomoda, Yuna Ogimi, Koichi Ito

Author information

Kiminori Sugino
Department of Surgery, Ito Hospital, Tokyo, Japan
Mitsuji Nagahama
Department of Surgery, Ito Hospital, Tokyo, Japan
Wataru Kitagawa
Department of Surgery, Ito Hospital, Tokyo, Japan
Keiko Ohkuwa
Department of Surgery, Ito Hospital, Tokyo, Japan
Takashi Uruno
Department of Surgery, Ito Hospital, Tokyo, Japan
Kenichi Matsuzu
Department of Surgery, Ito Hospital, Tokyo, Japan
Akifumi Suzuki
Department of Surgery, Ito Hospital, Tokyo, Japan
Chie Masaki
Department of Surgery, Ito Hospital, Tokyo, Japan
Junko Akaishi
Department of Surgery, Ito Hospital, Tokyo, Japan
Kiyomi Y. Hames
Department of Surgery, Ito Hospital, Tokyo, Japan
Chisato Tomoda
Department of Surgery, Ito Hospital, Tokyo, Japan
Yuna Ogimi
Department of Surgery, Ito Hospital, Tokyo, Japan
Koichi Ito
Department of Surgery, Ito Hospital, Tokyo, Japan

Keywords: Tyrosine kinase inhibitor, Differentiated thyroid cancer, Radioiodine therapy, Lenvatinib

JOURNAL FREE ACCESS FULL-TEXT HTML

2018 Volume 65 Issue 3 Pages 299-306

DOI https://doi.org/10.1507/endocrj.EJ17-0365

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Abstract

New insights in thyroid cancer biology propelled the development of targeted therapies as salvage treatment for radioiodine-refractory differentiated thyroid cancer (RR-DTC), and the tyrosine kinase inhibitor (TKI) lenvatinib has recently become available as a new line of therapy for RR-DTC. The aim of this study is to investigate clinical factors related to the efficacy of TKI therapy in recurrent RR-DTC patients and identify the optimal timing for the start of TKI therapy. The subjects consisted of 29 patients with progressive RR-DTC, 9 males and 20 females, median age 66 years. A univariate analysis was conducted in relation to progression free survival (PFS) and overall survival (OS) by the Kaplan-Meier method for the following variables: age, sex, histology of the primary tumor, thyroglobulin doubling time before the start of lenvatinib therapy, site of the target lesions, presence of a tumor-mediated symptom at the start of lenvatinib therapy, and baseline tumor size of the target lesions. Median duration of lenvatinib therapy was 14.7 months and median drug intensity was 9.5 mg. At the time of the data cut-off for the analysis, 9 patients (31.0%) have died of their disease (DOD), and a PR (partial response), SD (stable disease), and PD (progressive disease) were observed in 20 patients (69%), 6 patients (20.7%), 3 patients (10.3%), respectively. Univariate analyses showed that the presence of a symptom was the only factor significantly related to poorer PFS and OS. Clinical benefit of TKI therapy will be possibly limited when the therapy starts after tumor-mediated symptoms appear.

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