Clinical impact of a dose-escalation strategy for lenvatinib in differentiated thyroid cancer.

IF 2.4 3区 医学 Q3 ONCOLOGY
Ryutaro Onaga, Tomohiro Enokida, Susumu Okano, Takao Fujisawa, Nobukazu Tanaka, Yuta Hoshi, Takuma Kishida, Hideki Tanaka, Masanobu Sato, Naohiro Takeshita, Ryo Kuboki, Hiroshi Nishino, Makoto Ito, Makoto Tahara
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引用次数: 0

Abstract

Background:  Treatment options for patients with differentiated thyroid cancer (DTC) who experience disease progression on lenvatinib treatment are limited. Although dose escalation of treatment with tyrosine kinase inhibitors at disease progression has been reported across cancer types, clinical significance in patients with DTC has not been investigated.

Methods: We retrospectively reviewed patients with DTC who experienced disease progression on lenvatinib treatment from September 2011 to June 2022. We compared subjects who received dose-escalation treatment with standard treatment of termination at the time of initial disease progression. The escalated dose was decided by referencing to the previous effective and tolerated dose.

Results: Thirty-three patients were identified, 15 with dose escalation and 18 with lenvatinib termination. In both groups, the starting dose of lenvatinib was 24 mg/day, and the median dose at initial disease progression was 10 mg/day. In the former, the median dose escalation was 6 mg/day (range: 4-12). Objective response rate, clinical benefit rate by escalation, and median treatment duration of the dose-escalation phase were 13.3%, 73.3%, and 9.9 months (95% confidence interval [CI] 5.71-27.6), respectively. Median overall survival from initial disease progression was significantly longer in the dose-escalation group (median OS: 20.4 months [95% CI 7.0-NA] vs. 3.9 months [95% CI 1.7-7.9], log-rank p-value; 0.0004, hazard ratio; 0.22 [95% CI 0.09-0.55]). There were no grade 5 adverse events, and one patient discontinued due to a grade 3 lung abscess.

Conclusion: The dose-escalation strategy appears to be a safe and effective treatment option after disease progression in patients treated with lenvatinib for DTC.

Abstract Image

来伐替尼剂量递增策略对分化型甲状腺癌的临床影响
背景: 分化型甲状腺癌(DTC)患者在接受来伐替尼治疗后出现疾病进展,但治疗方案有限。尽管有报道称酪氨酸激酶抑制剂在疾病进展时的剂量升级适用于各种癌症类型,但尚未研究其对分化型甲状腺癌患者的临床意义:我们回顾性研究了2011年9月至2022年6月期间接受来伐替尼治疗并出现疾病进展的DTC患者。我们将接受剂量递增治疗的受试者与在最初疾病进展时终止标准治疗的受试者进行了比较。升级剂量参照之前的有效耐受剂量决定:结果:共确定了33名患者,其中15人接受了剂量升级治疗,18人接受了来伐替尼终止治疗。两组患者的来伐替尼起始剂量均为24毫克/天,疾病初始进展时的中位剂量均为10毫克/天。前者的中位剂量升级为6毫克/天(范围:4-12)。剂量递增阶段的客观反应率、临床获益率和中位治疗时间分别为13.3%、73.3%和9.9个月(95%置信区间[CI] 5.71-27.6)。剂量递增组患者自疾病初始进展起的中位总生存期明显更长(中位OS:20.4个月[95% CI 7.0-NA] vs. 3.9个月[95% CI 1.7-7.9],log-rank p值;0.0004,危险比;0.22 [95% CI 0.09-0.55])。没有出现5级不良反应,一名患者因出现3级肺脓肿而停药:结论:对于接受来伐替尼治疗的DTC患者,剂量递增策略似乎是疾病进展后一种安全有效的治疗方案。
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来源期刊
CiteScore
6.80
自引率
3.00%
发文量
175
审稿时长
2 months
期刊介绍: The International Journal of Clinical Oncology (IJCO) welcomes original research papers on all aspects of clinical oncology that report the results of novel and timely investigations. Reports on clinical trials are encouraged. Experimental studies will also be accepted if they have obvious relevance to clinical oncology. Membership in the Japan Society of Clinical Oncology is not a prerequisite for submission to the journal. Papers are received on the understanding that: their contents have not been published in whole or in part elsewhere; that they are subject to peer review by at least two referees and the Editors, and to editorial revision of the language and contents; and that the Editors are responsible for their acceptance, rejection, and order of publication.
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