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From Lenvatinib to Sorafenib to Reduce Nephrotoxicity in Thyroid Cancer: Case Study

By: Joseph Fanelli
Posted: Monday, January 4, 2021

According to a case study presented in the World Journal of Clinical Cases, transitioning from the tyrosine kinase inhibitor (TKI) lenvatinib to sorafenib seemed to improve anti-VEGF therapy–induced nephrotic syndrome in a patient with radioactive iodine–refractory differentiated thyroid cancer. Min Che Tung, MD, of Tungs’ Taichung Metro Harbor Hospital, Taiwan, and colleagues noted that the switch from lenvatinib to sorafenib also seemed to achieve cancer control.

“This study is the second published case report about the successful adaption from lenvatinib, a more potent tyrosine kinase inhibitor, to sorafenib, a less potent tyrosine kinase inhibitor, to improve the nephrotoxicity and, meanwhile, achieve the therapeutic goal of cancer control,” the authors concluded.

The case study featured a 56-year-old man with radioactive iodine–refractory differentiated thyroid cancer. After 1 month of receiving 20 mg/day of lenvatinib, the patient experienced bilateral edematous lower extremities and also developed hypertension. Lab reports showed grade 3 proteinuria, hypoalbuminemia, and hypercholesterolemia. Physicians made a diagnosis of anti-VEGF therapy–induced nephrotic syndrome.

Initially, the dosage of lenvatinib was reduced to 10 mg/day. This resulted in little improvement, though, so the patient’s treatment was changed to 400 mg/day of sorafenib. After 5 months of treatment, the patient’s hypertension and peripheral edema were “greatly improved,” and proteinuria was improved from grade 3 to 1. In addition, cancer control was achieved based on CT and laboratory evidence.

Disclosure: The authors reported no conflicts of interest.

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