Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer

Jaume Capdevila, Kate Newbold, Lisa Licitra, Aron Popovtzer, Francesc Moreso, José Zamorano, Michael Kreissl, Javier Aller, Enrique Grande

Research output: Contribution to journalReview article

Abstract

Lenvatinib has been approved for the treatment of advanced differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) following the results of the SELECT trial which demonstrated a significant increase in progression-free survival and a high response rates. The data reported for lenvatinib in RAI-refractory DTC (RAI-R DTC) are the most significant to date in this patient population, with a RECIST objective response rate above 60% and almost 80% reduction in the risk of disease progression. Because the first indication in oncology for lenvatinib is specifically in RAI-R DTC, a period of familiarisation with its safety and efficacy profile is required. This review includes a series of specific recommendations for optimising the management of RAI-R DTC with lenvatinib, as well as specific guidelines for minimising the incidence and severity of adverse events (AEs), which enable dose intensity to be increased and this way maximise the benefits of the drug in the patient population treated. These recommendations were defined at a meeting of experts of different specialities, reviewing available scientific evidence on the drug, as well as their own direct personal experience in daily clinical practice. For toxicity to be properly managed, a multidisciplinary approach is required in which the different medical services, nursing staff and the patient and their careers are all involved. It is essential to assess the suitability of patients who are candidates for lenvatinib, as well as their clinical and physiological status prior to treatment. They must then be closely monitored to prevent and detect possible AEs. The main objective should be to maintain the dose that obtains the maximum therapeutic effect, discontinuing the treatment only if the toxicity becomes unmanageable or there is no clinical benefit.

Original languageEnglish
Pages (from-to)164-176
Number of pages13
JournalCancer Treatment Reviews
Volume69
DOIs
Publication statusPublished - Sep 2018

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Thyroid Neoplasms
Iodine
Therapeutics
Nursing Staff
Therapeutic Uses
Risk Reduction Behavior
Pharmaceutical Preparations
Population
Disease-Free Survival
Disease Progression
lenvatinib
Guidelines
Safety
Incidence

Keywords

  • Adenocarcinoma/drug therapy
  • Cell Differentiation/drug effects
  • Humans
  • Iodine Radioisotopes/adverse effects
  • Phenylurea Compounds/therapeutic use
  • Prognosis
  • Protein Kinase Inhibitors/therapeutic use
  • Quinolines/therapeutic use
  • Radiation Tolerance/drug effects
  • Thyroid Neoplasms/drug therapy

Cite this

Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer. / Capdevila, Jaume; Newbold, Kate; Licitra, Lisa; Popovtzer, Aron; Moreso, Francesc; Zamorano, José; Kreissl, Michael; Aller, Javier; Grande, Enrique.

In: Cancer Treatment Reviews, Vol. 69, 09.2018, p. 164-176.

Research output: Contribution to journalReview article

Capdevila, J, Newbold, K, Licitra, L, Popovtzer, A, Moreso, F, Zamorano, J, Kreissl, M, Aller, J & Grande, E 2018, 'Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer', Cancer Treatment Reviews, vol. 69, pp. 164-176. https://doi.org/10.1016/j.ctrv.2018.06.019
Capdevila, Jaume ; Newbold, Kate ; Licitra, Lisa ; Popovtzer, Aron ; Moreso, Francesc ; Zamorano, José ; Kreissl, Michael ; Aller, Javier ; Grande, Enrique. / Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer. In: Cancer Treatment Reviews. 2018 ; Vol. 69. pp. 164-176.
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T1 - Optimisation of treatment with lenvatinib in radioactive iodine-refractory differentiated thyroid cancer

AU - Capdevila, Jaume

AU - Newbold, Kate

AU - Licitra, Lisa

AU - Popovtzer, Aron

AU - Moreso, Francesc

AU - Zamorano, José

AU - Kreissl, Michael

AU - Aller, Javier

AU - Grande, Enrique

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - Lenvatinib has been approved for the treatment of advanced differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) following the results of the SELECT trial which demonstrated a significant increase in progression-free survival and a high response rates. The data reported for lenvatinib in RAI-refractory DTC (RAI-R DTC) are the most significant to date in this patient population, with a RECIST objective response rate above 60% and almost 80% reduction in the risk of disease progression. Because the first indication in oncology for lenvatinib is specifically in RAI-R DTC, a period of familiarisation with its safety and efficacy profile is required. This review includes a series of specific recommendations for optimising the management of RAI-R DTC with lenvatinib, as well as specific guidelines for minimising the incidence and severity of adverse events (AEs), which enable dose intensity to be increased and this way maximise the benefits of the drug in the patient population treated. These recommendations were defined at a meeting of experts of different specialities, reviewing available scientific evidence on the drug, as well as their own direct personal experience in daily clinical practice. For toxicity to be properly managed, a multidisciplinary approach is required in which the different medical services, nursing staff and the patient and their careers are all involved. It is essential to assess the suitability of patients who are candidates for lenvatinib, as well as their clinical and physiological status prior to treatment. They must then be closely monitored to prevent and detect possible AEs. The main objective should be to maintain the dose that obtains the maximum therapeutic effect, discontinuing the treatment only if the toxicity becomes unmanageable or there is no clinical benefit.

AB - Lenvatinib has been approved for the treatment of advanced differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) following the results of the SELECT trial which demonstrated a significant increase in progression-free survival and a high response rates. The data reported for lenvatinib in RAI-refractory DTC (RAI-R DTC) are the most significant to date in this patient population, with a RECIST objective response rate above 60% and almost 80% reduction in the risk of disease progression. Because the first indication in oncology for lenvatinib is specifically in RAI-R DTC, a period of familiarisation with its safety and efficacy profile is required. This review includes a series of specific recommendations for optimising the management of RAI-R DTC with lenvatinib, as well as specific guidelines for minimising the incidence and severity of adverse events (AEs), which enable dose intensity to be increased and this way maximise the benefits of the drug in the patient population treated. These recommendations were defined at a meeting of experts of different specialities, reviewing available scientific evidence on the drug, as well as their own direct personal experience in daily clinical practice. For toxicity to be properly managed, a multidisciplinary approach is required in which the different medical services, nursing staff and the patient and their careers are all involved. It is essential to assess the suitability of patients who are candidates for lenvatinib, as well as their clinical and physiological status prior to treatment. They must then be closely monitored to prevent and detect possible AEs. The main objective should be to maintain the dose that obtains the maximum therapeutic effect, discontinuing the treatment only if the toxicity becomes unmanageable or there is no clinical benefit.

KW - Adenocarcinoma/drug therapy

KW - Cell Differentiation/drug effects

KW - Humans

KW - Iodine Radioisotopes/adverse effects

KW - Phenylurea Compounds/therapeutic use

KW - Prognosis

KW - Protein Kinase Inhibitors/therapeutic use

KW - Quinolines/therapeutic use

KW - Radiation Tolerance/drug effects

KW - Thyroid Neoplasms/drug therapy

U2 - 10.1016/j.ctrv.2018.06.019

DO - 10.1016/j.ctrv.2018.06.019

M3 - Review article

C2 - 30032061

VL - 69

SP - 164

EP - 176

JO - Cancer Treatment Reviews

JF - Cancer Treatment Reviews

SN - 0305-7372

ER -