Lori Wirth, MD, discusses the safety profiles of sorafenib and lenvatinib and provides clinical insights on managing or mitigating adverse effects.
Case: A 64-Year-Old Woman with DTC
Initial presentation
Clinical workup and initial treatment
Subsequent treatment and follow-up
This is a video synopsis/summary of a Case-Based Peer Perspective featuring Lori Wirth, MD.
Wirth compares the adverse event profiles of sorafenib and lenvatinib, noting their similarity as VEGFR multikinase inhibitors. Both drugs are associated with VEGFR-related adverse reactions such as hand-foot syndrome, hypertension, diarrhea, anorexia, weight loss, and fatigue. There is a slightly increased risk of thromboembolic disease and fistula formation with both agents. Sorafenib tends to cause more hand-foot syndrome and rash compared with lenvatinib, while lenvatinib is associated with more hypertension.
Management strategies for these adverse reactions include dose holds, dose reductions, and supportive care. For hypertension, Wirth emphasizes the importance of blood pressure control prior to starting therapy, home monitoring, and prompt intervention with antihypertensive agents. Involving a cardiologist can be helpful for refractory cases. Hand-foot syndrome can be managed with good skin care, keratolytics, and urea creams, with dermatologist input for severe cases. Dietary modifications, nutritional supplements, and consultation with dietitians can help manage chronic diarrhea.
Wirth notes that sorafenib might be the preferred first-line choice over lenvatinib for patients with difficult-to-control hypertension at baseline, as lenvatinib seems to precipitate more refractory hypertension.
Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.
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