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렌바티닙 사용과 관련된 고혈압과 단백뇨의 관리: 증례 보고

Management of Hypertension and Proteinuria after Treatment with Lenvatinib for Radioiodine Refractory Papillary Thyroid Carcinoma: a Case Report

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초록

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

Abstract

Lenvatinib, an oral multi-kinase inhibitor, is a valuable treatment option for advanced differentiated thyroid carcinoma. However, severe treatment-related adverse events occur up to 30% of the patients receiving lenvatinib, making it a challenge for clinicians to maintain this drug and therefore affecting the outcome of therapy. Blood vessel related events, such as hypertension or proteinuria, are among the most frequent adverse events. We present a case of 65-year-old man with radioactive iodine refractory papillary thyroid carcinoma with cervical lymph node metastasis and tracheal invasion receiving lenvatinib who developed proteinuria and worsening of hypertension. Management with repeated dose reductions and using supportive medications allowed this patient to continue lenvatinib with his disease stably controlled. Early detection of patients at risk for these adverse events and cautious administration of lenvatinib at appropriate level are crucial in managing patients receiving lenvatinib.

참고문헌 (9)

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  2. Matsui J, "Multi-kinase inhibitor E7080 suppresses lymph node and lung metastases of human mammary breast tumor MDA-MB-231 via inhibition of vascular endothelial growth factor-receptor (VEGF-R) 2 and VEGF-R3 kinase", Clin Cancer Res, 14(17), pp.5459~5465 (2008)
  3. Schlumberger M, "Lenvatinib versus placebo in radioiodinerefractory thyroid cancer", N Engl J Med, 372(7), pp.621~630 (2015)
  4. Brose MS, "Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial", Lancet, 384(9940), pp.319~328 (2014)
  5. Kiyota N, "Subgroup analysis of Japanese patients in a phase 3 study of lenvatinib in radioiodine-refractory differentiated thyroid cancer", Cancer Sci, 106(12), pp.1714~1721 (2015)
  6. Eremina V, "Vascular endothelial growth factor a signaling in the podocyte-endothelial compartment is required for mesangial cell migration and survival", J Am Soc Nephrol, 17(3), pp.724~735 (2006)
  7. Bollee G, "Thrombotic microangiopathy secondary to VEGF pathway inhibition by sunitinib", Nephrol Dial Transplant, 24(2), pp.682~685 (2009)
  8. Haddad RI, "Incidence and timing of common adverse events in Lenvatinib-treated patients from the SELECT trial and their association with survival outcomes", Endocrine, 56(1), pp.121~128 (2017)
  9. Cavalieri S, "Lenvatinib-induced renal failure: two first-time case reports and review of literature", Expert Opin Drug Metab Toxicol, 14(4), pp.379~385 (2018)

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