RESUMO
Purpose: Differentiated thyroid cancer (DTC) accounts for approximately 95% of thyroid carcinomas. In the metastatic RAI-refractory disease, chemotherapy has very limited efficacy and is associated with substantial toxicity. With increasing knowledge of the molecular pathogenesis of DTC, novel targeted therapies have been developed. Lenvatinib is a tyrosine kinase inhibitor (TKI) with promising clinical activity based on the randomized phase III SELECT trial. In Switzerland, a Named Patient Program (NPP) was installed to bridge the time gap to Swissmedic approval. Here, we report the results from the Swiss Lenvatinib NPP including patients with metastatic RAI-refractory DTC. Methods: Main inclusion criteria for the Swiss NPP were RAI-refractory DTC, documented disease progression, Eastern Cooperative Oncology Group (ECOG) performance status 0-3. The number of previous therapies was not limited. The Swiss Lenvatinib NPP was initiated in June 2014 and was closed in October 2015 with the approval of the drug. Results: Between June 2014 and October 2015, 13 patients with a median age of 72 years have been enrolled. Most patients (69%) had at least one prior systemic therapy, mainly sorafenib. 31% of patients showed a PR and 31% SD. Median progression free survival was 7.2 months and the median overall survival was 22.7 months. Dose reduction due to adverse events was necessary in 7 patients (53%). At the time of analysis 6 patients (47%) were still on treatment with a median time on treatment of 9.98 months. Conclusions: Our results show that lenvatinib has reasonable clinical activity in unselected patients with RAI-refractory thyroid cancer with nearly two-third of patients showing clinical benefit. The toxicity profile of lenvatinib is manageable.
RESUMO
Follicular lymphoma is an indolent and usually incurable disease. It has been, therefore, traditionally approached either by watch and wait or with single-agent treatments with the purpose of maintaining a good quality of life for a prolonged time. The emergence of more aggressive regimens including polychemotherapy, high-dose chemotherapy with stem-cell rescue and the positive effect of the addition of rituximab to the latter, have prompted many clinicians to abandon this minimalist strategy while trying to obtain a prolongation of survival or even cure by giving more intensive regimen at diagnosis or as soon as treatment was necessary. Because, at present, none of these new strategies was shown to lose their positive impact if used later in the treatment rather than upfront, we present here a management algorithm which should help clinicians in deciding which first-line regimen to use, taking into account the characteristics of the patients, of the disease and of the different treatments.
