Skin-Related Toxicity of Tyrosine Kinase Inhibitor in Thyroid Cancer

Dong-Jun Lim

doi:10.11106/ijt.2018.11.2.82

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Lim: Skin-Related Toxicity of Tyrosine Kinase Inhibitor in Thyroid Cancer

Case Report

International Journal of Thyroidology 2018; 11(2): 82-87.

Published online: 30 November 2018

DOI: https://doi.org/10.11106/ijt.2018.11.2.82

Skin-Related Toxicity of Tyrosine Kinase Inhibitor in Thyroid Cancer

Dong-Jun Lim

Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence: Dong-Jun Lim, MD, PhD, Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: 82-2-2258-6009, Fax: 82-2-599-3589, ldj6026@catholic.ac.kr

Received 25 October 2018 Revised 28 November 2018 Accepted 28 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

Skin-related toxicity is one of the most important adverse events from multi-target tyrosine kinase inhibitor (MTKI) to treat radioiodine refractory thyroid cancer. As hand foot skin reaction can limit quality of life and therapeutic effectiveness, it is essential to cope with a variety of severity of skin-related toxicity induced by MTKI. Herein, we will discuss two representative cases of skin-related toxicities which were managed by discontinuation/reduction of therapeutic doses of MTKI and were treated by proper medication in thyroid cancer patients with distant metastasis.

Keywords: Thyroid neoplasms, Protein kinase inhibitors, Hand-foot syndrome

Figures and Tables

Fig. 1

(A) A 5.0 cm sized large tumor mass with growing nature attached to a bronchus in right lower lobe. (B) After three-month sorafenib treatment, the size of large metastatic mass was reduced to 4.0 cm, without bleeding.

Fig. 2

Three weeks after start of sorafenib 800 mg per day, periungual swelling and multiple painful erythema occurred on both hands, indicating hand foot skin reaction (grade 3).

Fig. 3

(A) One 3.5 cm sized growing metastatic pulmonary mass in left lower lobe was refractory to sorafenib. (B) Tumor cavitation with decreased size (2.5 cm) occurred on three months after lenvatinib treatment.

Fig. 4

(A) Erythematous swelling and pruritus with several bleeding creases on right toes occurred on two-month lenvatinib treatment (14 mg per day). (B) Scrotal eczema showing erythematous plaques with pruritus on two-month lenvatinib treatment (14 mg per day).

Fig. 5

(A) Dominant two pulmonary metastatic nodules with small multiple spine metastases on PET/CT scan before lenvatinib treatment. (B) Progressive widespread metastatic lesions on whole body, including multiple spine lesions and soft tissue metastasis on PET/CT scan (three months after lenvatinib treatment).

Table 1

Symptoms and signs of hand-foot skin reaction (HFRS) and stepwise treatment

Modified from reference 9

References

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