PMID- 34395303
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220425
IS  - 2235-0640 (Print)
IS  - 2235-0802 (Electronic)
IS  - 2235-0640 (Linking)
VI  - 10
IP  - 4
DP  - 2021 Jul
TI  - High Prevalence and Conservative Management of Acute Cholecystitis during 
      Lenvatinib for Advanced Thyroid Cancer.
PG  - 314-322
LID - 10.1159/000510369 [doi]
AB  - INTRODUCTION: Lenvatinib (LEN) is a multitarget tyrosine kinase inhibitor 
      currently used for advanced, radioiodine refractory differentiated thyroid cancer 
      (RAI-R DTC). Among adverse events (AEs), nausea, vomiting, and decreased appetite 
      have been frequently described. We aimed to evaluate the prevalence, the clinical 
      presentation, and the effectiveness of conservative treatment of gallbladder 
      disorders in a consecutive series of patient treated with LEN. METHODS: Patients 
      with RAI-R DTC experiencing clinical symptoms suggestive for gallbladder 
      disorders during LEN treatment were evaluated with laboratory investigations and 
      contrast-enhanced abdominal computed tomography (CT) and ultrasound scan (US). 
      RESULTS: After a median time of 2 months from the start of treatment, 5/13 
      patients (38.4%) complained of gastrointestinal symptoms, with increased biliary 
      enzymes levels, especially gammaGT, and CT/US suggestive of acute cholecystitis (AC). 
      The onset of symptoms and the peak of gammaGT levels frequently corresponded to the 
      highest reduction in body weight during the first months of treatment. All 
      patients were treated with supportive care and, when appropriate, with 
      ursodeoxycholic acid; in 4 patients, LEN dose reduction or short interruption was 
      needed, too. CONCLUSIONS: In patients with RAI-R DTC treated with LEN, a high 
      prevalence of AC in the first months of treatment was documented. Mainly due to 
      the low specificity of symptoms such as anorexia, nausea, and vomiting, this AE 
      is likely to be frequently misdiagnosed. The onset of the disease was associated 
      to the weight loss observed during the first months of treatment and contributes 
      to further decrease in body weight. Therefore, particularly during the first 
      months of treatment, or at any time of huge reduction of body weight, monitoring 
      of gammaGT and US is crucial for prompt diagnosis and treatment. Conservative medical 
      treatment and LEN dosage titration, together with dietary and rehabilitative 
      supports, can limit or avoid the need for drug withdrawal and cholecystectomy.
CI  - Copyright (c) 2020 by European Thyroid Association Published by S. Karger AG, 
      Basel.
FAU - Di Stefano, Marta
AU  - Di Stefano M
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
FAU - Colombo, Carla
AU  - Colombo C
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
AD  - Department of Pathophysiology and Transplantation, University of Milan, Milan, 
      Italy.
FAU - De Leo, Simone
AU  - De Leo S
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
FAU - Perrino, Michela
AU  - Perrino M
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
FAU - Vigano, Mauro
AU  - Vigano M
AD  - Division of Hepatology, San Giuseppe Hospital Multimedica IRCCS, Milan, Italy.
FAU - Persani, Luca
AU  - Persani L
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
AD  - Department of Clinical Sciences and Community Health, Milan, Italy.
FAU - Fugazzola, Laura
AU  - Fugazzola L
AD  - Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 
      Milan, Italy.
AD  - Department of Pathophysiology and Transplantation, University of Milan, Milan, 
      Italy.
LA  - eng
PT  - Journal Article
DEP - 20200916
PL  - England
TA  - Eur Thyroid J
JT  - European thyroid journal
JID - 101604579
PMC - PMC8314780
OTO - NOTNLM
OT  - Cholecystitis
OT  - Lenvatinib
OT  - Thyroid cancer
OT  - Weight loss
COIS- M.D.S., C.C., S.D.L., M.P., M.V., and L.P. have no conflicts of interest to 
      declare. L.F. has a consultant relationship with Eisai.
EDAT- 2021/08/17 06:00
MHDA- 2021/08/17 06:01
PMCR- 2022/01/01
CRDT- 2021/08/16 06:01
PHST- 2020/06/15 00:00 [received]
PHST- 2020/07/22 00:00 [accepted]
PHST- 2021/08/16 06:01 [entrez]
PHST- 2021/08/17 06:00 [pubmed]
PHST- 2021/08/17 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - etj-0010-0314 [pii]
AID - 10.1159/000510369 [doi]
PST - ppublish
SO  - Eur Thyroid J. 2021 Jul;10(4):314-322. doi: 10.1159/000510369. Epub 2020 Sep 16.