Endocrine Abstracts

Objectives: Patients suffering from pulmonary or/and neoplastic disease are at higher risk of developing serious illness from SARS-CoV-2. TC patients with lung metastases are classified as high-risk for severe CoV-2 disease. Aim of this study was to investigate SARS-CoV-2 prevalence and severity in this particular subgroup of patients.

Methods: Out of 28 patients with metastatic Differentiated Thyroid Cancer (DTC) and 21 patients with metastatic Medullary Thyroid Cancer (MTC) followed-up in our Dept, 12 and 11 respectively, present lung metastases and they are under Tyrosine Kinase Inhibitors (TKIs) treatment. During a follow-up period of 18 months (from April-2020) SARS-CoV-2 infections (PCR-confirmed) as well as clinical course of TC patients with lung metastases were recorded.

Results: n=4/12 (33.3 %) DTC-patients were diagnosed with SARS-CoV-2. Two patients, a 68-year-old-female and a 50-year-old-male, with mediastinal lymph nodes/lung metastases, partial structural response to, Sorafenib-800 mg and Lenvatinib-14 mg respectively, experienced mild symptoms and further hospitalization was not required for them. The third patient, a 63-year-old-female, with mediastinal lymph nodes/lung/bone metastases, disease stabilization under Sorafenib-800 mg, required further hospitalization- for a total period of 20 days -with administration of Dexamethasone and Remdesivir; Sorafenib was discontinued during this period. The fourth patient, a 52-year-old-male, with lung/liver/bone metastases and disease progression under third line TKI Cabozantinib, succumbed to the disease during his hospitalization. n=3/11 (27.3 %) MTC-patients were diagnosed with SARS-CoV-2. Two patients, a 52-year-old-female and a 47-year-old-male, (sporadic MTCs), with lung metastases and disease stabilization under Vandetanib-300 mg, experienced mild symptoms and further hospitalization was not required for them. The third patient, a 34-year-old-female, (MEN2B), with lung/liver metastases and disease stabilization under Vandetanib-300 mg, suffering with concomitant Multiple-Sclerosis under immunomodulatory treatment, required further hospitalization- for a total period of 10 days -with administration of Dexamethasone and Remdesivir; Vandetanib discontinuation was not requisite. All six patients, during a follow-up period of at least two months, stay healthy with neither residual symptoms nor progression of the neoplastic disease to have been recorded. All but one (MEN2B patient) had undergone SARS-CoV-2 vaccination(BNT162b2).

Conclusions: TC patients with lung metastases, under TKIs treatment, are at high-risk of severe CoV-2 disease. Disease stabilization under TKIs as well as lower metastatic burden seem to be favourable prognostic factors regarding SARS-CoV-2 clinical course. TKIs discontinuation, when questioned, has to be performed under a multidisciplinary team (MDT) approach, with a cost-effectiveness analysis, balancing possible risks of neoplastic disease progression.