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Photoallergic reaction in a patient receiving vandetanib for metastatic follicular thyroid carcinoma: a case report.

ABSTRACT: Novel targeted agents have been increasingly developed and tested in clinical trials over the past 5-10 years, many with unknown and unanticipated side effects. We describe here a case of a patient with a history of metastatic follicular thyroid carcinoma that we believe developed vandetanib-associated photoallergic dermatitis while enrolled on a phase 1 clinical trial.A 51-year-old Caucasian female with poorly differentiated, metastatic follicular thyroid carcinoma presented with a cutaneous eruption that developed over 3 to 4 days while treated on phase 1 clinical trial with vandetanib-based therapy. Given the concern for photoallergic dermatitis, vandetanib was discontinued and supportive care provided including topical and oral steroid administration. Her cutaneous eruption improved and she was successfully re-challenged with vandetanib.Tyrosine kinase inhibitors, such as typo-vandetinib, with various therapeutic targets have come to the forefront of oncologic therapy in recent years. It is important to have a better understanding of the side effect profile and management in order to anticipate adverse events and maintain patient safety in future clinical trials.

SUBMITTER: Goldstein J

PROVIDER: S-EPMC4336708 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Photoallergic reaction in a patient receiving vandetanib for metastatic follicular thyroid carcinoma: a case report.

Goldstein Jennifer J Patel Anisha B AB Curry Jonathan L JL Subbiah Vivek V Piha-Paul Sarina S

BMC dermatology 20150213

<h4>Background</h4>Novel targeted agents have been increasingly developed and tested in clinical trials over the past 5-10 years, many with unknown and unanticipated side effects. We describe here a case of a patient with a history of metastatic follicular thyroid carcinoma that we believe developed vandetanib-associated photoallergic dermatitis while enrolled on a phase 1 clinical trial.<h4>Case presentation</h4>A 51-year-old Caucasian female with poorly differentiated, metastatic follicular th ...[more]

PMID: 25886034

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Project description:BACKGROUND:Tyrosine kinase inhibitors (TKIs) have been associated with elevated TSH as a drug class effect. Prior studies of vandetanib in adults with medullary thyroid carcinoma (MTC) described an increase in levothyroxine (LT) requirement. We studied TSH, free T4, and LT dosing in children and adolescents enrolled in the phase I/II trial of vandetanib for medullary thyroid cancer (MTC). METHODS:Data from 13 patients with multiple endocrine neoplasia type 2B (MEN 2B) and MTC were analyzed [6 M, 7 F, median age 13.0 y (9.1-17.3)] Eleven patients (85%) had undergone prior thyroidectomy and all received single-drug therapy with vandetanib for?>?6 months. Confirmed compliance with vandetanib (67-150 mg/m(2)/day) and LT was a necessary inclusion criterion. RESULTS:While on vandetanib treatment, all 11 athyerotic patients exhibited significantly increased TSH levels. The baseline TSH level was 4.37 mclU/ml (0.08 - 23.30); in comparison, the first peak TSH concentration on vandetanib was 15.70 mclU/ml (12.50 - 137.00, p?=?0.0010). The median time to reach the initial peak of elevated TSH was 1.8 months (0.3 - 9.3). Free T4 levels remained within the normal reference range. An increase from a baseline LT dose of 91 mcg/m(2)/day (±24) to 116 mcg/m(2)/day (±24) was required in order to resume normative TSH levels (p?=?0.00005), equal to an increase of 36.6% (±16.56) in the dosage of LT in mcg/day. For the 2 patients with intact thyroid glands, free T4 and TSH remained normal over a combined 6 patient years of follow up. CONCLUSIONS:In our cohort of pediatric MTC patients, athyreotic patients with preexisting hypothyroidism developed increased TSH and reduced free T4 during the first few months of treatment with vandetanib, necessitating an increase in LT dosage. Additional patients with normal thyroid function before treatment and intact glands (n?=?2) maintained normal thyroid function tests during treatment. Elevated TSH in athyreotic patients may be due to an indirect effect of vandetanib on the metabolism of thyroid hormone, or to altered TSH sensitivity at the pituitary. Proper recognition and management of abnormal thyroid hormone levels is critical in growing children on TKIs. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT00514046.

Dataset Information

Photoallergic reaction in a patient receiving vandetanib for metastatic follicular thyroid carcinoma: a case report.

Publications

Photoallergic reaction in a patient receiving vandetanib for metastatic follicular thyroid carcinoma: a case report.

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