Reactions 1704, p223 - 2 Jun 2018 Renal failure: 2 case reports In a case series, two patients, a 58-year-old man and a 59-year-old woman were described, who developed renal failure during treatment with lenvatinib [routes not stated]. Case 1: The 58-year-old man developed renal failure during treatment with lenvatinib. In 1998, at the age of 44-years, he was diagnosed with a papillary thyroid carcinoma. His history was remarkable for arterial hypertension (AH) for which he had been receiving doxazosin, atenolol, and chlortalidone. Later, he underwent total thyroidectomy. In 2007, he underwent a right selective neck dissection for locoregional relapse. He also received sorafenib between September 2010 and August 2011. In December 2011, due to lymph nodal progression, a left selective neck dissection was performed. In April 2012, he had bilateral pulmonary progression of the disease. Thereafter, in September 2012, at the age of 58 years, he received lenvatinib 24mg daily. His BP was well maintained with anti-hypertensive medications. At the second month of lenvatinib therapy, he achieved partial remission, though his baseline proteinuria became abnormal. At the fourth year of therapy, proteinuria worsened and became grade 3. Meanwhile, serum creatinine and BP also elevated. Then lenvatinib was discontinued and he was hospitalised. Ten days after the lenvatinib discontinuation, a kidney biopsy was performed, which showed a complex pattern of drug-related glomerular, tubulointerstitial and vascular renal injury. Within 4 weeks of discontinuation, his abnormal values returned to baseline. During follow-up, his lab investigation affirmed chronic kidney failure, which was attributed to lenvatinib. Case 2: The 59-year-old woman developed renal failure during treatment with lenvatinib. In 2015, the woman was diagnosed with steroid-resistant mild dyspnoea. Later, a whole body CT scan demonstrated enlarged mediastinal lymph nodes along with multiple liver metastases. She then received palliative chemotherapy with doxorubicin and cisplatin. Later, this was discontinued due to disease progression. She then enrolled in a phase II trial, where she received lenvatinib 24mg daily. One month later, lenvatinib was withheld due to garde 3 gastrointestinal-toxicity and resumed at 20mg daily. During this time period, her disease remained stable. In October 2016 i.e. 15 months from the lenvatinib initiation, she had a progressive impairment in renal function. Her serum creatinine, blood urea nitrogen became abnormal. Then lenvatinib was discontinued and within 2 days, she had remarkable improvement. Then lenvatinib was restarted at a daily dose of 14mg. Her serum creatinine, blood urea nitrogen again became abnormal. After the nephrology consultation, a clinical diagnosis of tubulointerstitial lenvatinib-induced nephropathy was made. She then started receiving prednisone along with lenvatinib. This made her renal function stable however she had disease progression. Then, lenvatinib and prednisone were discontinued. Later, she underwent trans- arterial chemo-embolisation (TACE), which made her alive without any disease-related symptoms. Author comment: "The case 1 presented for the first time the histological picture of lenvatinib-induced renal failure with a classical glomerular damage leading to secondary proteinuria and tubular failure. Case 2 showed an alternative lenvatinib-induced renal failure pattern of likely tubulointerstitial injury without proteinuria. These reports reflect two sides of the same coin, both to be considered in case of lenvatinib-induced renal failure" Cavalieri S, et al. Lenvatinib-induced renal failure: two first-time case reports and review of literature. [Review]. Expert Opinion on Drug Metabolism and Toxicology 14: 379-385, No. 4, Apr 2018. Available from: URL: http:// doi.org/10.1080/17425255.2018.1461839 - Italy 803322771 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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