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Lenvatinib complementary with radioiodine therapy for patients with advanced differentiated thyroid carcinoma: case reports and literature review.
Sheu, NW, Jiang, HJ, Wu, CW, Chiang, FY, Chiou, HC, Hsiao, PJ
World journal of surgical oncology. 2019;(1):84
Abstract
BACKGROUND The prognosis for patients with advanced differentiated thyroid carcinoma (ADTC) with disseminated distant metastases is very poor. Tyrosine kinase inhibitors targeting tumor angiogenesis have been shown to improve progression-free survival in patients with advanced thyroid carcinoma and progressive radioiodine-refractory thyroid carcinoma. Tyrosine kinase inhibitor has been reported as a successful neoadjuvant for total thyroidectomy to reduce tumor burden. However, the special indications for prompt treatment with lenvatinib as a rescue therapy to reduce tumor burden and prolong a durable response to radioiodine therapy have not been explored. CASE PRESENTATION Here, we present two ADTC cases with distant metastases who were effectively treated by total thyroidectomy combined with lenvatinib to prolong a durable response to radioiodine therapy. Case 1 was a 66-year-old male diagnosed with ADTC and disseminated brain, lung, and bone metastases. Lenvatinib was initiated via compassionate access because of rapidly progressive tumor growth even after second doses of radioiodine therapy and external beam radiation therapy for his brain metastases. The result was a durable response to lenvatinib, slowing progressive tumor growth for 3 years and allowing a third course of radioiodine therapy to treat the bone metastases. Case 2 was a 45-year-old male diagnosed with ADTC and diffuse disseminated lung metastases. Respiratory failure ensued after total thyroidectomy, requiring mandatory support by respirator. Lenvatinib was started as a rescue therapy to reduce tumor burden rapidly. The patient was successfully weaned off the respirator only 1 week after using lenvatinib. The patient was then maintained on a low dose of lenvatinib, allowing three subsequent courses of radioiodine therapy. Currently, his lung metastasis remains well controlled with decreased lung infiltrating nodules and the patient can tolerate exercise well. CONCLUSION Our case experience indicated that lenvatinib has significant value as salvage therapy, reducing tumor burden, producing a durable response and maintaining quality of life. For ADTC patients with progressive life-threatening metastases, our experience suggests that lenvatinib treatment can be used as an urgent rescue therapy as well as a complement to radioiodine therapy to improve tumor eradication.
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2.
Multitargeted Kinase Inhibition in Metastatic Differentiated Radioiodine-Refractory Thyroid Cancer: A Look at New Therapeutic Options for a Rare Disease.
Mischler, K, Kneifel, S, Cathomas, R
Oncology research and treatment. 2016;(9):548-52
Abstract
BACKGROUND Metastatic differentiated thyroid cancer (DTC) is a rare disease that is in the first line treated with iodine-131 radioisotope therapy. Until recently, options were very limited in the case of progressive radioactive-iodine (RAI)-refractory disease. Based on new study results, tyrosine kinase inhibitors (TKIs) have attracted attention. The TKI sorafenib demonstrated significantly improved progression-free survival (PFS) in a phase III trial. Recent data from another phase III trial showed that the TKI lenvatinib achieved high response rates and a large improvement in PFS in metastatic RAI-refractory DTC patients in the first-line setting and after 1 prior line of TKI. However, little is known about the response to lenvatinib in patients pretreated with multiple lines of TKIs. CASE REPORT We present the case of a 45-year-old man with metastatic RAI-refractory DTC progressing after multiple prior treatments with TKIs and chemotherapy. A very good and long-lasting response to lenvatinib was observed. Careful and prospective monitoring as well as management of side effects including dose adaptation were necessary to ensure success of treatment. CONCLUSION Here, we review different novel treatment options for patients with metastatic RAI-refractory DTC.
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3.
Telangiectasia macularis eruptive perstans (TMEP) in childhood: a case report and literature review.
Leonardi, S, Vitaliti, G, Praticò, AD, La Rosa, M
Allergologia et immunopathologia. 2012;(5):321-3
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Therapeutic Hotline: Cysteinyl leukotriene receptor antagonist montelukast in the treatment of atopic dermatitis.
Broshtilova, V, Gantcheva, M
Dermatologic therapy. 2010;(1):90-3
Abstract
Leukotrienes are potent proinflammatory mediators derived from arachidonic acid through the 5-lipoxygenase pathway. Experimental data suggest a role for cysteinyl leukotrienes in the pathogenesis of atopy giving a rationale for its use in asthma, allergic rhinitis, and chronic urticaria management. A few clinical observations and small trials suggest that montelukast may be used in an adjunctive manner as an effective therapeutic option for all age categories affected by moderate-to-severe atopic dermatitis. Our own observations proved that montelukast as a prospective corticosteroid-sparing option in the complex therapeutic strategy of corticosteroid-dependent atopic dermatitis patients, even in the severe erythrodermic cases.
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Churg-Strauss syndrome associated with montelukast therapy.
Girszyn, N, Amiot, N, Lahaxe, L, Cuvelier, A, Courville, P, Marie, I
QJM : monthly journal of the Association of Physicians. 2008;(8):669-71
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Churg-Strauss syndrome in two patients receiving montelukast.
Guilpain, P, Viallard, JF, Lagarde, P, Cohen, P, Kambouchner, M, Pellegrin, JL, Guillevin, L
Rheumatology (Oxford, England). 2002;(5):535-9
Abstract
OBJECTIVE Churg-Strauss syndrome (CSS) has been described in association with the treatment of asthmatic patients with leukotriene receptor antagonist. The main mechanism proposed to explain this condition is the unmasking of CSS after the leukotriene receptor antagonist has allowed corticosteroid tapering. Other hypotheses might be proposed. METHODS We describe two patients who developed CSS after starting treatment with montelukast, a new antileukotriene drug. RESULTS Both patients presented with CSS after 4-5 months of treatment with montelukast. Neither patient received long-term systemic steroids for asthma, but both were on inhaled steroids. One patient had a myocardial involvement and experienced a stroke. Our two patients were treated with systemic steroids and cyclophosphamide. CONCLUSIONS CSS does not appear to relate to steroid tapering in our patients. The other hypotheses are a coincidence or a direct adverse effect of the antileukotriene. Long-term data on these drugs are lacking and leukotriene's role in vasculitis remains to be elucidated.
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7.
[Churg-Strauss syndrome associated with montelukast therapy].
Sabadell, C, Jolis, R, Canalías, J
Medicina clinica. 2001;(4):159
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[Treatment of asthma with antileukotrienes and Churg-Strauss syndrome].
Sala Félix, J, Pereiro Alonso, ME, Salas Antón, C
Archivos de bronconeumologia. 2001;(1):48-50
Abstract
Since antileukotriene treatment for asthma was introduced, there has been debate about whether such therapy can lead to Churg-Strauss Syndrome (CSS) or whether CSS is simply inhibited by the use of steroids, as various authors have suggested. We report a case in which we suspected CSS in a patient with bronchopulmonary, cutaneous and analytical signs and whom we treated with oral steroids. After clinical improvement, one year later, steroids were replaced by antileukotrienes, after which the same clinical picture developed. The vasculitis characteristic of CSS was confirmed pathologically.