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ESMO 2020: Lenvatinib Plus Pembrolizumab in Metastatic Thyroid Carcinoma

By: Sarah Campen, PharmD
Posted: Thursday, October 15, 2020

The combination of lenvatinib and pembrolizumab appears to induce long-term remission and complete responses in patients with metastatic anaplastic or poorly differentiated thyroid carcinoma, according to the results of a small retrospective study and the first data from the prospective phase II ATLEP study. Christine Dierks, MD, of the University Medical Center Freiburg, Germany, and colleagues presented their findings at the European Society for Medical Oncology (ESMO) Virtual Congress 2020 (Abstract 1915P).

The lenvatinib and pembrolizumab combination was studied in 8 patients in the retrospective analysis and 20 patients in the ATLEP trial, including a total of 22 patients with aplastic thyroid carcinoma and 6 patients with poorly differentiated thyroid carcinoma, respectively. Lenvatinib was given at 24 mg and 20 mg daily in each trial, respectively, and pembrolizumab was given intravenously at 200 mg every 3 weeks for up to 36 months.

In the retrospective analysis, the best overall response in aplastic thyroid carcinoma was a complete response in 66% of patients; stable disease, 16%; and progressive disease, 16%. The best overall response in poorly differentiated carcinoma was a partial response (100%). The median progression-free survival was 17.75 months, and the median overall survival was 18.5 months. Despite metastasized disease at the start of therapy, three patients with aplastic thyroid carcinoma were alive without relapse.

In the ATLEP trial, the overall rate of response at 3 months was 30%, with 6 of 20 patients achieving a partial response. The current best overall response for all patients is partial response (40%), and all other patients have achieved stable disease (60%). Progression-free survival and overall survival have not yet been reached, and the trial will continue to enroll more patients.

As for safety, grade 3 or 4 toxicities were reported in four patients in the retrospective analysis, and eight patients in the ATLEP trial. The events included aspergillus pneumonia, hemorrhage, and fistulas.

Disclosure: The study authors reported no conflicts of interest.

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