Tailored management of advanced thyroid cancer patients treated with lenvatinib or vandetanib: the role of a multimodal approach

Alice Nervo; Matteo Ferrari; Elisa Vaccaro; Enrica Migliore; Giovanni Gruosso; Anna Roux; Alessandro Piovesan; Emanuela Arvat

doi:10.1007/s12020-024-04061-2

Tailored management of advanced thyroid cancer patients treated with lenvatinib or vandetanib: the role of a multimodal approach

Endocrine. 2024 Oct 2. doi: 10.1007/s12020-024-04061-2. Online ahead of print.

Authors

Alice Nervo¹, Matteo Ferrari², Elisa Vaccaro², Enrica Migliore³, Giovanni Gruosso², Anna Roux², Alessandro Piovesan², Emanuela Arvat²

Affiliations

¹ Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy. alice.nervo@gmail.com.
² Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy.
³ Cancer Epidemiology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy.

PMID: 39356445
DOI: 10.1007/s12020-024-04061-2

Abstract

Background: In differentiated/poorly differentiated (DTC/PDTC) or medullary thyroid cancer (MTC) treated with kinase inhibitors (KIs), additional treatments (ATs) can be performed in selected cases.

Methods: We retrospectively analysed all the ATs performed in our center in KI-treated TC patients, evaluating the subsequent KI modulation, the local PD in case of loco-regional procedure (LRP) and the AT-related complications. DTC/PDTC patients with or without progressive disease before the first AT (PD and NO PD GROUP, respectively) were analysed separately.

Results: In our center, 32 ATs (30 LRPs and 2 radioactive iodine treatments) were performed in 14 DTC/PDTC patients and 4 MTC subjects after the start of systemic therapy with lenvatinib or vandetanib (27 and 5 ATs, respectively). Brain was the most treated site (11/30 LRPs) and external beam radiation was the most employed LRP (18/30 LRPs). KIs dose reduction or discontinuation of KI therapy (at least transient) was performed after 50% of ATs in DTC/PDTC NO PD GROUP. The KI was maintained at the same dosage after 75% and 50% of the ATs performed in DTC/PDTC PD GROUP and MTC, respectively. During the follow-up, local PD was detected after 14 LRPs. Local progression-free survival (LPFS) was significantly shorter in DTC/PDTC PD GROUP in comparison to NO PD GROUP (12 month-LPFS 91.7% versus 15.2%); in patients with MTC, 12 month-LPFS was 50%. AT-related AEs were mostly G1-G2.

Conclusions: In selected DTC/PDTC without previous PD and treated with a multimodal strategy, local disease control is generally maintained regardless the KI dose modulation. In DTC/PDTC patients with previous limited PD and in MTC subjects, the choice of performing a LRP and continue the ongoing KI therapy must consider the risk of early local progression. AT-related AEs in KI treated patients were mild in most cases.

Keywords: Kinase inhibitor; Loco-regional treatment; Personalized therapy; Tumour board.