Management of VEGFR-Targeted TKI for Thyroid Cancer

SIMPLE SUMMARY: Anti-VEGFR therapy has become a mainstay of treatment for thyroid cancer across histological subtypes. However, the inhibition of this pathway is associated with particular adverse effects, some of which are life-threatening and may lead to the withdrawal of definitive treatment. To minimize this risk, the physician must recognize the characteristics of these adverse effects, including their timing and frequency, and adopt appropriate countermeasures. Moreover, management should more broadly encompass the appropriate subject selection for this treatment, as well as modification of the treatment schedule and consideration of alternative therapies for those patients harboring a risk of toxicity. ABSTRACT: Recent advances in the development of multitarget tyrosine kinase inhibitors (MTKIs), which mainly target the vascular endothelial growth factor receptor (VEGFR), have improved prognoses and dramatically changed the treatment strategy for advanced thyroid cancer. However, adverse events related to this inhibition can interrupt treatment and sometimes lead to discontinuation. In addition, they can be annoying and potentially jeopardize the subjects’ quality of life, even allowing that the clinical outcome of patients with advanced thyroid cancer remains limited. In this review, we summarize the potential mechanisms underlying these adverse events (hypertension, proteinuria and renal impairment, hemorrhage, fistula formation/gastrointestinal perforation, wound healing, cardiovascular toxicities, hematological toxicity, diarrhea, fatigue, and acute cholecystitis), their characteristics, and actual management. Furthermore, we also discuss the importance of related factors, including alternative treatments that target other pathways, the necessity of subject selection for safer administration, and patient education.