EEfficacy and safety of molecular targeting drugs in patients with metastatic thyroid cancer

Objective: We report on team medical care with molecular targeting drugs for metastatic thyroid cancer. Results: The team involved the departments of breast and endocrine surgery, medical oncology, dermatology, and radiation Oncology, as well as pharmacists and nurses. Sixteen patients (pts) received sorafenib (10) or lenvatinib (10, including 4 switched from sorafenib). There were 6 men and 10 women (median age: 69 years) with differentiated thyroid cancer (15) or Anaplastic carcinoma (1). Sorafenib was started at 800 mg, but was discontinued, reduced, or suspended due to adverse events. Median treatment period was 6.7 months. Maintenance dose was 400 mg in 6 pts treated for > 6 months. Response rate (RR) was 14% in 7 evaluable pts. Major adverse events were hand-and-foot syndrome (HFS) in 70%, malaise in 70%, and hypertension (HT), rash, and anorexia in 50% each. Three pts discontinued due to erythema exsudativum multiforme. There were no treatment-related deaths. Lenvatinib was started at 24 mg. Median treatment period was 2.1 months. In 4 pts treated for > 3 months, the maintenance dose was 20 mg (1), 14 mg (2), or 10 mg (1). RR was 50% in 8 evaluable pts. Major adverse events were HT in 80%, malaise in 70%, anorexia in 70%, HFS in 50%, and diarrhea in 30%. There were 2 treatment-related deaths (bleeding). Conclusions: The cross-departmental team set individual strategies, allowing longer dosing of molecular targeting drugs.