Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4883-4894
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4883
Improvement of lenvatinib-induced nephrotic syndrome after adaptation to sorafenib in thyroid cancer: A case report
Che Hseuh Yang, Kuo Tung Chen, Yi Sheng Lin, Chao Yu Hsu, Yen Chuan Ou, Min Che Tung
Che Hseuh Yang, Yi Sheng Lin, Chao Yu Hsu, Yen Chuan Ou, Min Che Tung, Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung City 435403, Taiwan
Kuo Tung Chen, Division of General Surgery, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung City 435403, Taiwan
Author contributions: Yang CH was the primary care of this case and responsible for the original draft; Chen KT was the primary surgeon of him and consulted Lin YS, urologist, for adverse effects from lenvatinib; Chen KT and Lin YS were both responsible for reviewing this draft; Ou YC provided comments to this literature; Hsu CY and Tung MC were responsible for the important intellectual content and supervisor; informed consent was conducted by Chen KT.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Sheng Lin, MD, Attending Doctor, Surgeon, Surgical Oncologist, Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, No. 699 Sec. 8, Taiwan Blvd., Wuqi District, Taichung City 435403, Taiwan. tung12197@gmail.com
Received: July 17, 2020
Peer-review started: July 17, 2020
First decision: August 22, 2020
Revised: August 28, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 26, 2020
Abstract
BACKGROUND

Target therapy is licensed by United States Food and Drug Administration on certain cancers. Both sorafenib and lenvatinib are tyrosine kinase inhibitor and indicated on radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). Lenvatinib is more effective in cancers' control than sorafenib, but causes more nephrotoxicity than sorafenib does. This case is the second published case about the serial adaptions from lenvatinib to sorafenib for improving the proteinuria and, meanwhile, achieving the therapeutic goal.

CASE SUMMARY

A 56-year-old man suffered from bilateral edematous lower extremities after 1-mo prescription of lenvatinib of 20 mg/d for RAI-refractory DTC. Aside from this symptom, he also developed hypertension. His laboratory showed grade-3 proteinuria (estimated 24-h urine protein: 9993 mg), hypoalbuminemia and hypercholesterolemia. Anti-vascular endothelial growth factor (VEGF) therapy-induced nephrotic syndrome was impressed. After reduced dosage of lenvatinib of 10 mg/d and related symptomatic drugs, limited improvement was observed in both adverse effects and caner control. Under this condition, we substituted sorafenib of 400 mg/d for lenvatinib of 10 mg/d. After a 5-mo prescription, not only hypertension and peripheral edema were greatly improved, but also proteinuria was improved from grade three to grade one (estimated 24-h urine protein: 962 mg). At the same time the cancer control was achieved, judged from computed tomography and laboratory evidence [thyroglobulin (Tg) before prescription of sorafenib: 354.7 ng/mL; Tg after prescription of sorafenib: 108.9 ng/mL].

CONCLUSION

Adaption from lenvatinib to sorafenib is a feasible method to improve the anti-VEGF therapy-induced nephrotic syndrome and achieve the therapeutic goal at the same time.

Keywords: Molecular targeted therapy/methods, Receptors, Vascular endothelial growth factor/drug effects, Vascular endothelial growth factor/therapeutic use, Vascular endothelial growth factor A/drug effects, Nephrotic syndrome/drug therapy, Case report

Core Tip: Trials of anti-vascular endothelial growth factor (VEGF) therapy mostly focused on drugs with more potent to its receptors and with better progression-free survival, but few reports discussed about nephrotoxicity induced by anti-VEGF drugs, especially achieving improvement by regimens’ adaptions. This study is the second published case report about the successful adaption from lenvatinib, a more potent tyrosine kinase inhibitor (TKI), to sorafenib, a less potent TKI, to improve the nephrotoxicity and, meanwhile, achieve the therapeutic goal of cancer control.