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Rapid disease progression after discontinuation of lenvatinib in thyroid cancer

Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11....

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Autores principales: Yamazaki, Haruhiko, Sugino, Kiminori, Matsuzu, Kenichi, Masaki, Chie, Akaishi, Junko, Hames, Kiyomi, Tomoda, Chisato, Suzuki, Akifumi, Uruno, Takashi, Ohkuwa, Keiko, Kitagawa, Wataru, Nagahama, Mitsuji, Masuda, Munetaka, Ito, Koichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220477/
https://www.ncbi.nlm.nih.gov/pubmed/32176066
http://dx.doi.org/10.1097/MD.0000000000019408
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author Yamazaki, Haruhiko
Sugino, Kiminori
Matsuzu, Kenichi
Masaki, Chie
Akaishi, Junko
Hames, Kiyomi
Tomoda, Chisato
Suzuki, Akifumi
Uruno, Takashi
Ohkuwa, Keiko
Kitagawa, Wataru
Nagahama, Mitsuji
Masuda, Munetaka
Ito, Koichi
author_facet Yamazaki, Haruhiko
Sugino, Kiminori
Matsuzu, Kenichi
Masaki, Chie
Akaishi, Junko
Hames, Kiyomi
Tomoda, Chisato
Suzuki, Akifumi
Uruno, Takashi
Ohkuwa, Keiko
Kitagawa, Wataru
Nagahama, Mitsuji
Masuda, Munetaka
Ito, Koichi
author_sort Yamazaki, Haruhiko
collection PubMed
description Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11.1% and the median time to occurrence of the flare phenomenon ranged from 7 to 12 days in previous reports. In this study, we investigate the timing and incidence of the flare phenomenon in thyroid cancer patients treated with lenvatinib. The records of patients treated with lenvatinib were retrospectively reviewed. The primary outcomes were the incidence rate and timing of the flare phenomenon after the discontinuation of lenvatinib. The flare phenomenon was defined as death, hospitalization attributable to tumor progression, or unexpected event (e.g., pleural drainage) within 1 month of lenvatinib cessation. We excluded patients with progression of underlying diseases other than thyroid cancer or infection, those in whom the disease progressed, or those who died without achieving a clinical response (stable disease, partial response, or complete response). In total, 8 (14.3%) of the 56 patients experienced the flare phenomenon. The median time from lenvatinib cessation to the flare phenomenon was 9 (range, 4–30) days. Three patients in the flare group died within 1 month of lenvatinib cessation without an imaging evaluation. The remaining 5 patients had dyspnea and pleural effusion, and pleural drainage was performed in 3 of the 5 patients. Lenvatinib was resumed in 4 of the 8 patients in the flare group. Median overall survival (OS) was 15.1 months in the flare group and 41.9 months in the non-flare group. The OS tended to be poor in the flare group than in the non-flare group; however, this difference was not statistically significant (P = .051). In lenvatinib treatment for thyroid cancer, the incidence and timing of the flare phenomenon were similar to those observed with other TKIs. OS tended to be poor in the flare group than in the non-flare group. Further studies are needed to determine the mechanism of the flare phenomenon and establish measures and treatment policies.
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spelling pubmed-72204772020-06-15 Rapid disease progression after discontinuation of lenvatinib in thyroid cancer Yamazaki, Haruhiko Sugino, Kiminori Matsuzu, Kenichi Masaki, Chie Akaishi, Junko Hames, Kiyomi Tomoda, Chisato Suzuki, Akifumi Uruno, Takashi Ohkuwa, Keiko Kitagawa, Wataru Nagahama, Mitsuji Masuda, Munetaka Ito, Koichi Medicine (Baltimore) 5700 Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11.1% and the median time to occurrence of the flare phenomenon ranged from 7 to 12 days in previous reports. In this study, we investigate the timing and incidence of the flare phenomenon in thyroid cancer patients treated with lenvatinib. The records of patients treated with lenvatinib were retrospectively reviewed. The primary outcomes were the incidence rate and timing of the flare phenomenon after the discontinuation of lenvatinib. The flare phenomenon was defined as death, hospitalization attributable to tumor progression, or unexpected event (e.g., pleural drainage) within 1 month of lenvatinib cessation. We excluded patients with progression of underlying diseases other than thyroid cancer or infection, those in whom the disease progressed, or those who died without achieving a clinical response (stable disease, partial response, or complete response). In total, 8 (14.3%) of the 56 patients experienced the flare phenomenon. The median time from lenvatinib cessation to the flare phenomenon was 9 (range, 4–30) days. Three patients in the flare group died within 1 month of lenvatinib cessation without an imaging evaluation. The remaining 5 patients had dyspnea and pleural effusion, and pleural drainage was performed in 3 of the 5 patients. Lenvatinib was resumed in 4 of the 8 patients in the flare group. Median overall survival (OS) was 15.1 months in the flare group and 41.9 months in the non-flare group. The OS tended to be poor in the flare group than in the non-flare group; however, this difference was not statistically significant (P = .051). In lenvatinib treatment for thyroid cancer, the incidence and timing of the flare phenomenon were similar to those observed with other TKIs. OS tended to be poor in the flare group than in the non-flare group. Further studies are needed to determine the mechanism of the flare phenomenon and establish measures and treatment policies. Wolters Kluwer Health 2020-03-13 /pmc/articles/PMC7220477/ /pubmed/32176066 http://dx.doi.org/10.1097/MD.0000000000019408 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 5700
Yamazaki, Haruhiko
Sugino, Kiminori
Matsuzu, Kenichi
Masaki, Chie
Akaishi, Junko
Hames, Kiyomi
Tomoda, Chisato
Suzuki, Akifumi
Uruno, Takashi
Ohkuwa, Keiko
Kitagawa, Wataru
Nagahama, Mitsuji
Masuda, Munetaka
Ito, Koichi
Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title_full Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title_fullStr Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title_full_unstemmed Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title_short Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
title_sort rapid disease progression after discontinuation of lenvatinib in thyroid cancer
topic 5700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220477/
https://www.ncbi.nlm.nih.gov/pubmed/32176066
http://dx.doi.org/10.1097/MD.0000000000019408
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