Int J Thyroidol.  2022 May;15(1):42-48. 10.11106/ijt.2022.15.1.42.

Lung Related Complications in Patients with Advanced Thyroid Cancer during Lenvatinib Therapy: Case Series and Literature Review

• Yoon JH
• Hong AR
• Kim HK
• Kang HC

• KMID: 2530125
• DOI: http://doi.org/10.11106/ijt.2022.15.1.42

Abstract

Lenvatinib prolongs the survival of patients with advanced thyroid cancer. At initiation of lenvatinib therapy, advanced thyroid cancer patients frequently have lung metastasis and are vulnerable to pulmonary complications due to concealed lung damage caused by previous therapies including radioactive iodine (RAI) therapy. Among 24 patients treated with lenvatinib, pulmonary events were observed in three patients with lung metastasis, including one with interstitial lung disease (ILD) and two with pneumothorax. One patient who was previously treated with 750 mCi RAI developed uncontrolled ILD after lenvatinib therapy and died of respiratory failure. Two pneumothorax cases had previous cavitation of metastatic lung nodules. Pneumothorax resolved spontaneously in both patients. Pulmonary events in patients with lung metastases treated with lenvatinib are uncommon and manageable in most cases, but may be fatal if detection and management are delayed. Special attention should be given to patients with lung metastasis treated with high cumulative dose of RAI therapy or cavitary changes that develop after lenvatinib therapy.

Keyword

Advanced thyroid cancer; Tyrosine kinase inhibitor (TKI); Lenvatinib; Pneumothorax

Figure

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  Fig. 1 Chest CT scan of 82-year-old male with lung metastasis from follicular variant papillary thyroid cancer (Case 1). (A) Chest CT scan before lenvatinib therapy. (B) Chest CT scan at 2 months after starting lenvatinib therapy. (C) Chest CT of the time that a patient had acute respiratory failure (10 days after chest CT [B]).

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  Fig. 2 Chest CT scan of 49-year-old female with lung metastasis from anaplastic thyroid cancer (Case 2). (A) Chest CT scan before lenvatinib therapy. (B) Chest CT scan at 3 months after lenvatinib therapy. (C) Chest CT scan of the time pneumothorax occurred at 353 days after lenvatinib administration.

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  Fig. 3 Chest CT scan of 80-year-old female with lung metastasis from poorly differentiated thyroid cancer (Case 3). (A) Post-radioactive therapy with 131I (RAI) whole body scan. (B) 18FDG positron emission tomography/computed tomography (PET/CT). (C) Chest CT scan before lenvatinib therapy. (D) Chest CT scan of the time pneumothorax occurred at 10 months after lenvatinib therapy. (E) Chest CT scan at 3 months after lenvatinib related pneumothorax occurrence.

Reference

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