In:
Hormone and Metabolic Research, Georg Thieme Verlag KG, Vol. 53, No. 03 ( 2021-03), p. 149-160
Abstract:
Notwithstanding regulatory approval of lenvatinib and sorafenib to treat
radioiodine-refractory differentiated thyroid carcinoma (RAI-R DTC), important questions and controversies persist regarding this use of these
tyrosine kinase inhibitors (TKIs). RAI-R DTC experts from German tertiary referral centers convened to identify and explore such issues; this paper
summarizes their discussions. One challenge is determining when to start TKI therapy. Decision-making should be shared between patients and
multidisciplinary caregivers, and should consider tumor size/burden, growth rate, and site(s), the key drivers of RAI-R DTC morbidity and
mortality, along with current and projected tumor-related symptomatology, co-morbidities, and performance status. Another question involves choice of first-line TKIs. Currently, lenvatinib is generally preferred, due to
greater increase in progression-free survival versus placebo treatment and higher response rate in its pivotal trial versus that of sorafenib;
additionally, in those studies, lenvatinib but not sorafenib showed overall survival benefit in subgroup analysis. Whether recommended maximum or lower
TKI starting doses better balance anti-tumor effects versus tolerability is also unresolved. Exploratory analyses of lenvatinib pivotal study data
suggest dose-response effects, possibly favoring higher dosing; however, results are awaited of a prospective comparison of lenvatinib starting
regimens. Some controversy surrounds determination of net therapeutic benefit, the key criterion for continuing TKI therapy: if tolerability is
acceptable, overall disease control may justify further treatment despite limited but manageable progression. Future research should assess potential
guideposts for starting TKIs; fine-tune dosing strategies and further characterize antitumor efficacy; and evaluate interventions to prevent
and/or treat TKI toxicity, particularly palmar-plantar erythrodysesthesia and fatigue.
Type of Medium:
Online Resource
ISSN:
0018-5043
,
1439-4286
Language:
English
Publisher:
Georg Thieme Verlag KG
Publication Date:
2021
detail.hit.zdb_id:
2056576-8
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