Int J Thyroidol.  2018 Nov;11(2):82-87. 10.11106/ijt.2018.11.2.82.

Skin-Related Toxicity of Tyrosine Kinase Inhibitor in Thyroid Cancer

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. ldj6026@catholic.ac.kr

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.

Keyword

Thyroid neoplasms; Protein kinase inhibitors; Hand-foot syndrome

MeSH Terms

Foot
Hand
Hand-Foot Syndrome
Humans
Neoplasm Metastasis
Protein Kinase Inhibitors
Protein-Tyrosine Kinases*
Quality of Life
Skin
Thyroid Gland*
Thyroid Neoplasms*
Tyrosine*
Protein Kinase Inhibitors
Protein-Tyrosine Kinases
Tyrosine

Figure

  • 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).


Reference

1. Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014; 384(9940):319–328.
Article
2. Schlumberger M, Tahara M, Wirth LJ, Robinson B, Brose MS, Elisei R, et al. Lenvatinib versus placebo in radioiodinerefractory thyroid cancer. N Engl J Med. 2015; 372(7):621–630.
Article
3. Chanprapaph K, Rutnin S, Vachiramon V. Multikinase inhibitor-induced hand-foot skin reaction: A review of clinical presentation, pathogenesis, and management. Am J Clin Dermatol. 2016; 17(4):387–402.
Article
4. Resteghini C, Cavalieri S, Galbiati D, Granata R, Alfieri S, Bergamini C, et al. Management of tyrosine kinase inhibitors (TKI) side effects in differentiated and medullary thyroid cancer patients. Best Pract Res Clin Endocrinol Metab. 2017; 31(3):349–361.
Article
5. Jean GW, Mani RM, Jaffry A, Khan SA. Toxic effects of sorafenib in patients with differentiated thyroid carcinoma compared with other cancers. JAMA Oncol. 2016; 2(4):529–534.
Article
6. Erber R, Thurnher A, Katsen AD, Groth G, Kerger H, Hammes HP, et al. Combined inhibition of VEGF and PDGF signaling enforces tumor vessel regression by interfering with pericyte-mediated endothelial cell survival mechanisms. FASEB J. 2004; 18(2):338–340.
7. Jain L, Gardner ER, Figg WD, Chernick MS, Kong HH. Lack of association between excretion of sorafenib in sweat and hand-foot skin reaction. Pharmacotherapy. 2010; 30(1):52–56.
Article
8. Brose MS, Cabanillas ME, Cohen EE, Wirth LJ, Riehl T, Yue H, et al. Vemurafenib in patients with BRAF(V600E)-positive metastatic or unresectable papillary thyroid cancer refractory to radioactive iodine: a non-randomised, multicentre, open-label, phase 2 trial. Lancet Oncol. 2016; 17(9):1272–1282.
Article
9. Brose MS, Frenette CT, Keefe SM, Stein SM. Management of sorafenib-related adverse events: a clinician's perspective. Semin Oncol. 2014; 41:Suppl 2. S1–S16.
Article
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