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High Prevalence and Conservative Management of Acute Cholecystitis during Lenvatinib for Advanced Thyroid Cancer
European Thyroid Journal ( IF 4.7 ) Pub Date : 2020-09-16 , DOI: 10.1159/000510369
Marta Di Stefano 1 , Carla Colombo 1, 2 , Simone De Leo 1 , Michela Perrino 1 , Mauro Viganò 3 , Luca Persani 1, 4 , Laura Fugazzola 1, 2
Affiliation  

Introduction: Lenvatinib (LEN) is a multitarget tyrosine kinase inhibitor currently used for advanced, radioiodine refractory differentiated thyroid cancer (RAI-R DTC). Among adverse events (AEs), nausea, vomiting, and decreased appetite have been frequently described. We aimed to evaluate the prevalence, the clinical presentation, and the effectiveness of conservative treatment of gallbladder disorders in a consecutive series of patient treated with LEN. Methods: Patients with RAI-R DTC experiencing clinical symptoms suggestive for gallbladder disorders during LEN treatment were evaluated with laboratory investigations and contrast-enhanced abdominal computed tomography (CT) and ultrasound scan (US). Results: After a median time of 2 months from the start of treatment, 5/13 patients (38.4%) complained of gastrointestinal symptoms, with increased biliary enzymes levels, especially γGT, and CT/US suggestive of acute cholecystitis (AC). The onset of symptoms and the peak of γGT levels frequently corresponded to the highest reduction in body weight during the first months of treatment. All patients were treated with supportive care and, when appropriate, with ursodeoxycholic acid; in 4 patients, LEN dose reduction or short interruption was needed, too. Conclusions: In patients with RAI-R DTC treated with LEN, a high prevalence of AC in the first months of treatment was documented. Mainly due to the low specificity of symptoms such as anorexia, nausea, and vomiting, this AE is likely to be frequently misdiagnosed. The onset of the disease was associated to the weight loss observed during the first months of treatment and contributes to further decrease in body weight. Therefore, particularly during the first months of treatment, or at any time of huge reduction of body weight, monitoring of γGT and US is crucial for prompt diagnosis and treatment. Conservative medical treatment and LEN dosage titration, together with dietary and rehabilitative supports, can limit or avoid the need for drug withdrawal and cholecystectomy.
Eur Thyroid J


中文翻译:

乐伐替尼治疗晚期甲状腺癌期间急性胆囊炎的高患病率和保守治疗

简介: Lenvatinib (LEN) 是一种多靶点酪氨酸激酶抑制剂,目前用于晚期放射性碘难治性分化型甲状腺癌 (RAI-R DTC)。在不良事件 (AE) 中,经常描述恶心、呕吐和食欲下降。我们的目的是在一系列接受 LEN 治疗的患者中评估保守治疗胆囊疾病的患病率、临床表现和有效性。方法:通过实验室检查和增强腹部计算机断层扫描 (CT) 和超声扫描 (US) 对 RAI-R DTC 患者在 LEN 治疗期间出现提示胆囊疾病的临床症状进行评估。结果:在开始治疗的中位时间 2 个月后,5/13 患者 (38.4%) 抱怨胃肠道症状,胆道酶水平升高,尤其是 γGT,CT/US 提示急性胆囊炎 (AC)。症状的出现和 γGT 水平的峰值通常对应于治疗前几个月体重的最大减少。所有患者均接受支持治疗,并在适当时给予熊去氧胆酸;在 4 名患者中,还需要减少 LEN 剂量或短暂中断。结论:在接受 LEN 治疗的 RAI-R DTC 患者中,记录了在治疗的最初几个月中 AC 的高患病率。主要由于厌食、恶心和呕吐等症状的特异性低,这种AE很可能被误诊。疾病的发作与治疗前几个月观察到的体重减轻有关,并有助于进一步减轻体重。因此,特别是在治疗的最初几个月,或在体重大幅下降的任何时候,监测γGT和US对于及时诊断和治疗至关重要。保守的药物治疗和 LEN 剂量滴定,连同饮食和康复支持,可以限制或避免停药和胆囊切除术的需要。
欧洲甲状腺杂志
更新日期:2020-09-16
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