5PSQ-158 Off-label use of pembrolizumab in PD-L1 positive metastatic anaplastic thyroid carcinoma: a case report. (14th March 2021)

• Record Type: Journal Article
• Authors: Giordano, SMA; Scaldaferri, M; Caiazza, E; Cattel, F
• Is Part Of: European journal of hospital pharmacy. Volume 28(2021)Supplement 1
• Page Start: A134
• Page End: A134
• Publication Date: 2021-03-14
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2021-eahpconf.277
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background and importance: Anaplastic thyroid carcinoma (ATC) is a rare aggressive carcinoma representing 1–2% of all thyroid carcinomas. For patients with metastatic ATC, systemic chemotherapy with taxanes, platinum compounds or adriamycin is recommended. Several studies have shown that BRAF mutated tumours have higher expression of programmed death ligand 1 (PD-L1) (82%) compared with BRAF wild-type tumours (13%). For patients with metastatic ATC, systemic chemotherapy with taxanes, platinum compounds or adriamycin is recommended. Aim and objectives: To describe the clinical case of a 38-year-old man with BRAF negative and PD-L1 positive metastatic ATC, treated with pembrolizumab. This drug is not indicated for ATC treatment but its off-label use in combination with lenvatinib is justified by one study 1 and a few case reports. 2 3 Material and methods: At the end of 2019, the patient presented with paraesthesia and slight swelling in the mandibular, and in March 2020 a progressive increase in the volume of the lesion was observed. From March to April 2020, evaluations were carried and multifocal infiltrations in the mandible, thyroid, liver, lungs, bones, bone marrow and vena cava inferior were observed. Blood tests (thyroglobulin value was 6468 ng/mL) and thyroid biopsy were performed and the results confirmed the diagnosis of metastatic ATC. Because of the spread of the metastases and the speed of development of carcinoma, radiotherapy and surgery were not indicated. Therefore, the patient was treated with paclitaxel 80 mg/m 2 once a week combined with lenvatinib 14 mg/day. Metastatic progression was observed by CT after 20 days. Treatment with pembrolizumab 200 mg every 3 weeks combined with lenvatinib 14 mg/day was started. Results: After 3 months from the start of pembrolizumab and after 14 weeks from the start of lenvatinib, a reduction in thyroglobulin was detected (4906 ng/mL) and the results of vertebral MR and mandibular CT showed a reduction in metastases. Currently, the treatment is ongoing (six doses administered) and is well tolerated. Conclusion and relevance: Pembrolizumab combined with lenvatinib seemed to be effective in treating metastatic ATC and could become a therapeutic choice for patients presenting with PD-L1 expression. References and/or acknowledgements: https://pubmed.ncbi.nlm.nih.gov/29996921/ https://pubmed.ncbi.nlm.nih.gov/31885948/ https://pubmed.ncbi.nlm.nih.gov/31637475/ Conflict of interest: No conflict of interest