Reactions 1429 - 24 Nov 2012

Antineoplastics

Various toxicities: case reportA 57-year-old woman with thyroid cancer developed

various toxicities while receiving two regimens of cytotoxicchemotherapy and three lines of multikinase inhibitorchemotherapy [routes, durations of treatment to reactionsonset and outcomes not stated].

The woman, who had metastatic iodine-refractory poorlydifferentiated thyroid cancer, received six cycles ofdoxorubicin 60 mg/m2 and cisplatin 40 mg/m2 every4 weeks between October 2006 and March 2007. Shedeveloped grade 1 asthenia, grade 1 nausea, grade 3alopecia and grade 1 anaemia. In January 2008, she wasenrolled in a randomised, phase II trial of vandetanib versusplacebo. Following a 3-month placebo period, she wascrossed over to vandetanib 300 mg/day. Adverse effectsincluded grade 1 abdominal pain and grade 2 diarrhoea.Vandetanib was discontinued in July 2008, at which timenew lung metastases were seen on a CT scan. In October2008, she started receiving off-label sorafenib 800 mg/day.She developed grade 1-2 diarrhoea, grade 1 nausea,grade 2 loss of appetite, grade 1-2 asthenia, grade 2 weightloss, alopecia and grade 1 hand-foot syndrome. Six cyclesof second-line chemotherapy with paclitaxel 175 mg/m2

and carboplatin AUC 5 were administered every 4 weeks.Due to grade 2 neurotoxicity, chemotherapy wasdiscontinued in August 2009. Off-label sunitinib37.5 mg/day was initiated in March 2010, and shesubsequently developed grade 2 digestive toxicity andweight loss. Her disease progressed in November 2010.The dosage of sunitinib was increased to 50 mg/day, butshe died in March 2011 with pleural effusion.

Author comment: "The patient described here receivedthree lines of TKI [tyrosine kinase inhibitor]. . . All thesemultikinase inhibitors induce a number of adverse effects thatsometimes significantly impair quality of life. Our patientpresented fatigue, weight loss, digestive and skin toxicity,which were limited to grades 1 or 2."Crouzeix G, et al. Unusual short-term complete response to two regimens ofcytotoxic chemotherapy in a patient with poorly differentiated thyroid carcinoma.Journal of Clinical Endocrinology and Metabolism 97: 3046-3050, No. 9, Sep2012. Available from: URL: http://dx.doi.org/10.1210/jc.2012-1630 -France 803079958

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Reactions 24 Nov 2012 No. 14290114-9954/10/1429-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved