The role of lenvatinib in different types of thyroid cancer.

Introduction: Advanced and progressive thyroid cancer (TC) such as radioiodine-refractory thyroid cancer (RAIR-TC), presents a significant clinical challenge due to its poorer prognosis and limited therapeutic options. Lenvatinib is an oral multi-targeted tyrosine kinase approved as first line for the treatment of RAIR-TC.

Evidence acquisition: We provide a comprehensive review of lenvatinib in the management of advanced thyroid cancer including RAIR-TC, poorly differentiated (PDTC), anaplastic (ATC) and medullary thyroid carcinoma (MTC). A search was carried out on PubMed up to July 2024 to identify all relevant studies. The research was performed using the terms "thyroid neoplasms" (MeSH Terms) AND "lenvatinib" (MeSH Terms).

Evidence synthesis: Lenvatinib demonstrated beneficial outcomes in treating RAIR-TC with most patients achieving either partial response or stable disease, which led to its approval by regulatory agencies worldwide. In PDTC, lenvatinib demonstrated potential therapeutic usefulness, whereas its efficacy as a monotherapy in ATC has yielded less consistent outcomes. However, in ATC the combination of lenvatinib with immune check point inhibitors (such as pembrolizumab) seem promising. In MTC, the available data is limited to phase II studies. Adverse effects of any grade occur in almost all lenvatinib-treated patients and mostly have a time specific sequence of occurrence. Therapy discontinuations due to adverse events are not uncommon, and in some cases, drug-related fatalities may occur.

Conclusions: Lenvatinib demonstrated clinical efficacy and safety in both clinical trials and real-world studies for the treatment of patients with different types of thyroid cancer.