Lenvatinib-related renal microangiopathy: a case series.

Autor: Delsante M; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy., Monroy-Trujillo JM; Department of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Carter-Monroe N; VA Medical Center, Baltimore, MD, USA., Ball DW; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Rosenberg AZ; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA. arosen34@jhmi.edu.
Jazyk: angličtina
Zdroj: Virchows Archiv : an international journal of pathology [Virchows Arch] 2022 Feb; Vol. 480 (2), pp. 467-473. Date of Electronic Publication: 2021 May 06.
DOI: 10.1007/s00428-021-03114-5
Abstrakt: Tyrosine kinase inhibitors play an important role in the armamentarium against cancer. Lenvatinib is a multiple kinase inhibitor approved by the Food and Drugs Administration (FDA) for the treatment of advanced and radioresistant thyroid carcinomas and, in combination with everolimus, for renal cell carcinoma and unresectable hepatocellular carcinoma. The anti-tumoral activity is largely dependent on inhibition of neo-angiogenesis, and established side effects of anti-angiogenetic therapeutics include renal thrombotic microangiopathy (TMA). Here, we describe three cases of biopsy-proven renal TMA clinically presenting with proteinuria and stable serum creatinine in patients receiving lenvatinib for thyroid cancer. Microangiopathic lesions included glomerular basement membrane reduplication with segmental cellular interposition, mesangiolysis, and focal intracapillary and arteriolar thrombi. Drug-dose reduction or withdrawal was effective in renal function preservation, but cancer progressed in all patients. The management of lenvatinib-induced renal TMA remains a challenge. The best therapy in these patients is still uncertain. Earlier and more precise measurement of urine protein levels, allowing for early dose adjustment, could be effective in preventing further damage and drug discontinuation.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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