Adverse Events of Tyrosine Kinase Inhibitors in Patients with Advanced Thyroid Cancer

Min Joo Kim; Young Joo Park

doi:10.11106/ijt.2018.11.2.61

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This article has been corrected. See "Corrigendum: Adverse Events of Tyrosine Kinase Inhibitors in Patients with Advanced Thyroid Cancer" in Volume 12 on page 70.

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Kim and Park: Adverse Events of Tyrosine Kinase Inhibitors in Patients with Advanced Thyroid Cancer

Review Article

International Journal of Thyroidology 2018; 11(2): 61-70.

Published online: 30 November 2018

DOI: https://doi.org/10.11106/ijt.2018.11.2.61

Adverse Events of Tyrosine Kinase Inhibitors in Patients with Advanced Thyroid Cancer

Min Joo Kim^1,², Young Joo Park¹

¹Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

²Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.

Correspondence: Young Joo Park, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-4183, Fax: 82-2-764-2199, yjparkmd@snu.ac.kr

Received 15 October 2018 Revised 16 November 2018 Accepted 16 November 2018

The Korean Thyroid Association

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tyrosine kinase inhibitors (TKIs) are widely used for the treatment of advanced radioiodine-refractory thyroid cancer. Although the previous studies including large-scale randomized controlled trials have demonstrated the effects of TKIs in advanced thyroid cancers, it has been found that most patients experienced adverse events (AEs). Unlike other cancers, even patients with advanced thyroid cancers are often asymptomatic. Rather, TKI use can make patients suffer adverse events. Therefore, the use of TKI should be decided after the full consideration of AEs as well as its efficacies. While using TKI, AEs should be monitored, evaluated, and managed appropriately, if AEs develop. In this review, the occurrence, evaluation, and management of AEs of sorafenib, lenvatinib, and vandetanib will be described, which TKIs are most commonly used for the treatment of advanced thyroid cancer. Some suggestions for the management of AEs in the real life are also provided.

Keywords: Adverse events, Lenvatinib, Sorafenib, Thyroid cancer, Vandetanib

Figures and Tables

Fig. 1

Adverse event record (Reprint with permission from Reference 20. Copyright 2013 Endocrine Society).

Table 1

Safety overview for sorafenib in differentiated thyroid cancers

DECISION: randomized double-blind placebo-controlled phase 3 trial, IQR: interquartile range, NA: not mentioned, SD: standard deviation

Table 2

Incidence of adverse events with sorafenib in thyroid cancers

DECISION: randomized double-blind placebo-controlled phase 3 trial, NA: not mentioned

Table 3

Incidence of adverse events with lenvatinib in differentiated thyroid cancers

SELECT: selenium and vitamin E cancer prevention trial

Table 4

Incidence of adverse events with vandetanib in medullary thyroid cancers

ECG: electrocardiogram, ZETA: Zactima Efficacy in Thyroid Cancer Assessment

Table 5

Grades of common terminology criteria for adverse events (CTCAE)

ADL: activity of daily living, BSA: body surface area, TPN: total parenteral nutrition, ULN: unique learner number, WNL: within normal limit

Table 6

Patients discouraging TKI treatment

ALT: alanine aminotransferse, AST: aspartate aminotransferase, ECOG: Eastern Cooperative Oncology Group, TKI: tyrosine kinase inhibitors, TSH: thyroid stimulating hormone

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