SELECT: lenvatinib versus placebo in radioiodine-refractory differentiated thyroid cancer
The multikinase inhibitor lenvatinib delayed progression by almost fifteen months compared with placebo in iodine-refractory differentiated thyroid cancer and shrank tumours in two thirds of patients, becoming the preferred drug for this disease.
Overview
Phase 3 placebo-controlled trial of 392 patients with progressive radioiodine-refractory differentiated thyroid cancer randomised 2:1 to lenvatinib 24 mg daily or placebo.
Median progression-free survival was 18.3 versus 3.6 months (hazard ratio 0.21) and response 64.8 versus 1.5 percent; hypertension, diarrhoea, fatigue and proteinuria led to dose reductions in most patients, and there were six treatment-related deaths.
- Median progression-free survival 18.3 vs 3.6 months; hazard ratio 0.21.
- Objective response 64.8 percent vs 1.5 percent.
Lenvatinib is the first-choice kinase inhibitor for progressive iodine-refractory papillary and follicular thyroid cancer, reserved for symptomatic or rapidly progressing disease because of its toxicity.
- No overall survival benefit because of crossover.
- Starting dose debate; 18 mg was not non-inferior in a later study.
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