Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4883
Peer-review started: July 17, 2020
First decision: August 22, 2020
Revised: August 28, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 26, 2020
Processing time: 100 Days and 18.8 Hours
Target therapy is licensed by United States Food and Drug Administration on certain cancers. Both sorafenib and lenvatinib are tyrosine kinase inhibitor and indicated on radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). Lenvatinib is more effective in cancers' control than sorafenib, but causes more nephrotoxicity than sorafenib does. This case is the second published case about the serial adaptions from lenvatinib to sorafenib for improving the proteinuria and, meanwhile, achieving the therapeutic goal.
A 56-year-old man suffered from bilateral edematous lower extremities after 1-mo prescription of lenvatinib of 20 mg/d for RAI-refractory DTC. Aside from this symptom, he also developed hypertension. His laboratory showed grade-3 proteinuria (estimated 24-h urine protein: 9993 mg), hypoalbuminemia and hypercholesterolemia. Anti-vascular endothelial growth factor (VEGF) therapy-induced nephrotic syndrome was impressed. After reduced dosage of lenvatinib of 10 mg/d and related symptomatic drugs, limited improvement was observed in both adverse effects and caner control. Under this condition, we substituted sorafenib of 400 mg/d for lenvatinib of 10 mg/d. After a 5-mo prescription, not only hypertension and peripheral edema were greatly improved, but also proteinuria was improved from grade three to grade one (estimated 24-h urine protein: 962 mg). At the same time the cancer control was achieved, judged from computed tomography and laboratory evidence [thyroglobulin (Tg) before prescription of sorafenib: 354.7 ng/mL; Tg after prescription of sorafenib: 108.9 ng/mL].
Adaption from lenvatinib to sorafenib is a feasible method to improve the anti-VEGF therapy-induced nephrotic syndrome and achieve the therapeutic goal at the same time.
Core Tip: Trials of anti-vascular endothelial growth factor (VEGF) therapy mostly focused on drugs with more potent to its receptors and with better progression-free survival, but few reports discussed about nephrotoxicity induced by anti-VEGF drugs, especially achieving improvement by regimens’ adaptions. This study is the second published case report about the successful adaption from lenvatinib, a more potent tyrosine kinase inhibitor (TKI), to sorafenib, a less potent TKI, to improve the nephrotoxicity and, meanwhile, achieve the therapeutic goal of cancer control.