Lenvatinib

Abstract

Thrombocytopenia: case report An 82-year-old woman developed grade 3 thrombocytopenia during treatment with lenvatinib for metastatic thyroid cancer. The woman, who had left neck pain, was admitted to the hospital. She had a significant history of lumbar spondylosis, cholelithiasis cholecystolithiasis, osteoarthritis of both knees and common bile duct stones. Additionally, she was diagnosed with thyroid cancer 21 years prior to presentation. She had undergone a total thyroidectomy and right cervical lymph node dissection. In July 2016, a cervical ultrasound was performed which showed a mass. Subsequent cytology report of aspirated fluid of cervical mass showed recurrence of papillary cancer. In October 2016, she presented to the hospital with left neck pain (current presentation). Upon presentation, she was found to have a palpable tumour mass in the left supraclavicular fossa. Then, based on further clinical investigation, she was diagnosed with the anaplastic transformation of thyroid cancer with lymph node metastasis. Due to tumour infiltration, the surgical resection of tumour was not possible. Hence, the physician decided to initiate radiotherapy followed by lenvatinib therapy. In December 2016, she received radiotherapy 64.8Gy/54 Fr. From January 2017, she started receiving oral lenvatinib at a dose of 14 mg/day. Subsequently, she developed grade 3 thrombocytopenia secondary to lenvatinib therapy [duration of treatment to reaction onset not stated]. The woman’s lenvatinib dose was gradually reduced to 10 mg/day with one week on and one week off frequency. Then, the dose of lenvatinib was further reduced to 8mg/day with one week on and one week off frequency. However, her thrombocytopenia persisted. Hence, the dose of lenvatinib was again reduced to 4 mg/day for 1 week. Four weeks from the initiation of lenvatinib, a CT scan was performed which showed shrunk tumour. However, after 1.5 years, she was diagnosed with diverticula haemorrhage. Hence, lenvatinib therapy was re-initiated with a 1 week on and 2 weeks off frequency [reaction outcome not stated].