Journal Article

First effectiveness data of lenvatinib and pembrolizumab as first-line therapy in advanced anaplastic thyroid cancer: a retrospective cohort study

Penzkofer, Tobias, Spranger, Joachim, Mogl, Martina T., Karadeniz, Zehra, Horst, David, Bischoff, Philip, Frisch, Anne, Mai, Knut, Jensen, Marie, Soll, Dominik, Keilholz, Ulrich

2024

Overview

Background Anaplastic thyroid cancer (ATC) is a rare and aggressive neoplasm. We still lack effective treatment options, so survival rates remain very low. Here, we aimed to evaluate the activity of the combination of lenvatinib and pembrolizumab as systemic first-line therapy in ATC. Methods In a retrospective analysis, we investigated the activity and tolerability of combined lenvatinib (starting dose 14 to 24 mg daily) and pembrolizumab (200 mg every three weeks) as first-line therapy in an institutional cohort of ATC patients. Results Five patients with metastatic ATC received lenvatinib and pembrolizumab as systemic first-line therapy. The median progression-free survival was 4.7 (range 0.8–5.9) months, and the median overall survival was 6.3 (range 0.8-not reached) months. At the first follow-up, one patient had partial response, three patients had stable disease, and one patient was formally not evaluable due to interference of assessment by concomitant acute infectious thyroiditis. This patient was then stable for more than one year and was still on therapy at the data cutoff without disease progression. Further analyses revealed deficient DNA mismatch repair, high CD8 + lymphocyte infiltration, and low macrophage infiltration in this patient. Of the other patients, two had progressive disease after adverse drug reactions and therapy de-escalation, and two died after the first staging. For all patients, the PD-L1 combined positive score ranged from 12 to 100%. Conclusions The combination of lenvatinib and pembrolizumab was effective and moderately tolerated in treatment-naïve ATC patients with occasional long-lasting response. However, we could not confirm the exceptional responses for this combination therapy reported before in pretreated patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Anaplastic thyroid cancer / Antibodies, Monoclonal, Humanized / Antimitotic agents / Antineoplastic agents / Cancer / Cancer immunotherapy / Cancer therapies / CD8 antigen / Chemotherapy / Cloning / Cohort analysis / Diabetes / Disease / DNA repair / Endocrinology / Genetic testing / Humans / Immunotherapy / Infiltration / Kinase inhibitor / Kinases / Lenvatinib / Lymphocytes / Macrophages / Medical prognosis / Medicine / Medicine & Public Health / Metabolic Diseases / Metastases / Metastasis / Mismatch repair / Monoclonal antibodies / Oncology, Experimental / Patients / PD-L1 protein / Pembrolizumab / Phenylurea Compounds / Quinolines / Retrospective Studies / rology / Software / Surgery / Targeted cancer therapy / Thyroid cancer / Thyroid Carcinoma, Anaplastic - drug therapy / Thyroid Carcinoma, Anaplastic - pathology / Thyroid Neoplasms - drug therapy / Thyroid Neoplasms - pathology / Thyroiditis / Tomography / Tumors