Real-World Outcomes of Lenvatinib in RAI-Refractory Differentiated Thyroid Cancer

Francis P. Worden, MD, professor of medicine at the University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, discusses how the effectiveness of lenvatinib (Lenvima) in this real-world setting compares with results from other clinical trials.

The study involved patients who started treatment with lenvatinib between 2015 and 2020 and experts looked at response rates, progression-free survival and overall survival.

Transcription:

0:09 | The issue that arises with RAI-refractory differentiated thyroid cancer is that the recommendation is to obtain next-generation sequencing to look for driver mutations. A lot of [patients with] papillary thyroid cancer express a mutant BRAF V600E.

0:45 | We have targeted therapy for the V600E mutations that was approved by the FDA in an agnostic approval and means that any tumor type that has this kind of mutant driver can be treated with this combination of drugs, so I think there are some who believe that this should be the first treatment of choice.

1:16 | There was only really 1 public study that looked at this in a prospective manner, and that was from MD Anderson. They compared darafenib [Tafinlar] and trametinib [Mekinist] to darafenib. There was not really a difference in progression-free survival, but the data shows that when we looked at response rates, they are about half of what we see in SELECT at about 30% or 35% as compared [with] 62%. In our real-world experience, our responses were somewhere around 72%.

1:55 | In our analysis here, we know that patients do well with these mutations when treated with lenvatinib. In essence, we are not robbing them of an opportunity by not providing treatment with directed or targeted therapy upfront. In essence, it probably makes the most sense for us to start with these agents, especially if [patients] have bulky disease or a rapidly growing disease, because you want to gain control of the cancer. Even on the NCCN guidelines, they talk about the use of dabrafenib and trametinib is a second line after an effective therapy has been given such as lenvatinib. So, what this poster is saying is that we are supporting the guidelines in showing in a real-world experience that patients with these mutations do just as well, perhaps better, than starting with a targeted therapy upfront.

REFERENCE:

Worden FP, Wirth LJ, Reynolds N, et al. Patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) with BRAF V600E and/or K601E mutation status: A real-world view of effectiveness of lenvatinib monotherapy. J Clin Oncol. 2024;42(suppl 16):6098. doi.org:10.1200/JCO.2024.42.16_suppl.6098