Endocrine Abstracts

Background: Hypertension (HTN) is the most frequent adverse event during treatment with Lenvatinib (LEN) for advanced Radioactive Iodine-Resistant Thyroid Cancer (RAI-R TC), but data on its best therapeutic management are limited.

Objectives: To assess incidence, features and best management of LEN-related HTN in a consecutive single tertiary-care Centre.

Methods: Evaluation included 29 patients treated with LEN, followed for a mean time of 29.8 months (6-77 months).

Results: After a mean follow-up of 6.8 months, HTN was recorded in 76% of cases, as a de novo appearance in half of them. HTN significantly correlated with LEN dose (P = 0.011), and was of grade 1, grade 2 and grade 3 in 5%, 50% and 45% of patients, respectively. The majority (77%) of patients with HTN developed proteinuria, although no correlation was found (P = 0.187). Moreover, there was no correlation between HTN and patients clinical-pathological features or any other Adverse Event (AE), except for diarrhoea (P = 0.025). Specifically, patients with or without any pre-existing cardiovascular disease had a similar incidence of HTN during LEN, thus excluding the impact of this potential predisposing factor. Regarding tumour response according to RECIST Criteria 1.1, Objective Response Rate (ORR), Progression Free Survival (PFS) and Overall Survival (OS) during LEN treatment were not significantly different between patients who developed and patients who did not develop HTN (respectively: P = 0.291, log-rank P = 0.217, log-rank P = 0.150). After evaluation by a dedicated cardiologist, medical treatment was introduced in 21/22 patients: 1/21 in monotherapy and 20/21 multi-therapy. Calcium channel blockers (CCBs) were used in 81% of patients, either in monotherapy (5% of cases) or, in case of poor blood pressure control, in association with other anti-hypertensive drugs as ACE-inhibitors (ACE-i) or Beta-blockers (BB) (14%), with Angiotensin Receptor Blockers (ARB)/ACE-i + other anti-hypertensive drug (43%) or with a total of 4 anti-hypertensive drugs in 24% of patients. The firstly introduced drug was in most cases a CCB due to its effect on vasodilation; if necessary, an ACE-i/ARB was added, also for its effect on proteinuria. Hypertension control was obtained in 19/22 patients. No patient had to reduce or discontinue LEN treatment due to HTN.

Conclusion: HTN is a frequent and early adverse event in patients on LEN treatment. We suggest a diagnostic-therapeutic algorithm to be applied in clinical practice to allow efficient HTN control and improve patient compliance, reducing LEN discontinuation.