Differentiated Thyroid Cancer with a Focus on Adverse Event Management - Episode 4

Managing Adverse Events in RAI-Refractory DTC Therapy

An expert endocrinologist perspective on managing the toxicities associated with lenvatinib when treating RAI-refractory DTC and the role of dose reduction and interruption.

Steven I. Sherman, MD, FACE: Managing the adverse events associated with lenvatinib therapy starts with proper patient education. At the time of initiating treatment, it’s critical that patients understand what to expect. Not to frighten them but to give them the tools that they need to appropriately manage the therapy. Remember that the longer the patient remains on lenvatinib, the less we have to interrupt their therapy, the more likely they are to achieve a prolonged improvement in their progression-free survival.

We start by making them aware of the common adverse effects, such as hypertension, and structuring a blood pressure monitoring strategy that they have to follow at home. We have them report their blood pressure every week or 2 to the clinic so that we can manage this proactively.

It’s important to make them aware of the diarrhea and the nausea. We send them home with prescriptions from the beginning for medications that they’ll use if or when they develop those symptoms. For fatigue, weight loss, and decreased appetite, it’s important for them to become aware and to help them focus their planning on maximizing the nutrition value from the foods that they eat. Of course, making them aware that sometimes symptomatic improvements come from certain medications to help support their appetite.

A key strategy is dose reduction when patients have an intolerable degree of adverse effects; when they get to grade 2 or 3 adverse effects. Sometimes dose interruption is necessary to allow the severity of the adverse effect to abate. Sometimes we have to get creative with the dosing, and we have patients who may take their lenvatinib, not every day necessarily but for 2 weeks at a time, and then interrupt for a few days to allow their adverse effects to reduce.

It’s very important to remain creative in thinking about how to maximize the amount of time that a patient can remain on therapy because of that basic principle. The longer they’re able to stay on the drug, the longer it will be able to help them.

Transcript edited for clarity.