Managing tyrosine kinase inhibitors side effects in thyroid cancer

ABSTRACT

Background: Tyrosine kinase inhibitors (TKIs) are a new group of drugs that show the activity against receptors of different growth factors leading to the inhibition of tumor cells growth and proliferation. To date, four different TKIs have been approved for RAI-refractory DTC or MTC: sorafenib, lenvatinib, vandetanib and cabozantinib.

Methods: This review focuses on treatment toxicity related to above-mentioned TKIs administration in thyroid carcinoma.

Results: TKIs cause a variety of side effects in nearly all treated patients, among them: hypertension, gastrointestinal disturbances (diarrhea, abdominal pain, nausea, vomiting), skin reactions (rashes, acne, hand-foot syndrome), fatigue and weight loss. Most of side effects are mild and moderate and manageable by dose adjustment (dose interruptions and dose reductions) and concomitant therapy. However, some complications although rare may be life-threatening or even fatal.

Conclusion​: TKIs shows an acceptable toxicity profile in patients with advanced and progressive RAI refractory DTC and MTC but only in experienced hands familiar with TKIs, particularly with diagnostics and management of treatment-related complications and also with thyroid carcinoma, what is essential to safely care for the patients and keep them on kinase inhibitor therapy as long as the treatment is beneficial without an unfavorable impact on their quality of life.

KEYWORDS:

• Sorafenib
• lenvatinib
• vandetanib
• cabozantinib
• tyrosine kinase inhibitor
• side effect
• differentiated thyroid cancer
• medullary thyroid cancer

Declaration of interest

J Krajewska has participated in a Bayer HealthCare Pharmaceuticals Advisory Board. E Paliczka-Cieslik has nothing to disclose. B Jarzab has participated in AstraZeneca and Sobi Advisory Boards and has received honoraria from Sanofi, Ipsen, Novartis, Amgen, Bayer HealthCare Pharmaceuticals, Pfizer, Roche, Eisai, Oxigene and Exelixis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The article was supported by the Polish National Center of Research and Development, MILESTONE project – Molecular diagnostics and imaging in individualized therapy for breast, thyroid and prostate cancer, grant no. STRATEGMED 2/267398/4/NCBR/2015.​