Myocardial Infarction after Long-Term Treatment with a Tyrosine Kinase Inhibitor (TKI) with Anti-VEGF Receptor Activity

Case Reports in Endocrinology
14 Jun, 2019 ,

A 73-year-old female patient with metastatic thyroid papillary carcinoma was treated with total thyroidectomy. The operation was followed by four radioiodine therapies over a period of 6 years. At 6 years she developed lung metastasis without radioiodine uptake, one solitary liver metastasis and one solitary right renal metastasis. One year after the first diagnosis of radioiodine resistant lung metastasis the lung metastasis showed progression according to RECIST criteria. 

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We report a 73-year-old female patient with metastatic thyroid papillary carcinoma who was treated with total thyroidectomy. The operation was followed by four radioiodine therapies over a period of 6 years. At 6 years she developed lung metastasis without radioiodine uptake, one solitary liver metastasis and one solitary right renal metastasis. One year after the first diagnosis of radioiodine resistant lung metastasis the lung metastasis showed progression according to RECIST criteria.

The patient was therefore enrolled in the phase III study comparing lenvatinib to placebo. After the study ended the patient was unblinded. Lenvatinib treatment resulted in prolonged partial response with disappearance of the hepatic and renal metastasis. During further treatment with lenvatinib with dose reduction from initially 24 to 10 mg at 17 months of lenvatinib treatment a myocardial infarction occurred after 39 months of lenvatinib treatment resulting in implantation of 3 stents and a two chamber pacemaker.

Treatment with lenvatinib was discontinued at the time of diagnosis of the myocardial infarction. Except for well controlled hypertension there were neither predisposing diseases like diabetes nor symptoms of cardiac ischemia on exertion. Quarterly repeated echocardiography at rest showed normal results during the first two years of lenvatinib treatment during the phase III study. However, the family history for cardiovascular diseases was positive for cardiac infarction reported for one brother. Another brother was treated for hypertension and the patients’ mother suffered from a cerebral infarction at the age of 60.