Improvement of lenvatinib-induced nephrotic syndrome after adaptation to sorafenib in thyroid cancer:A case report

BACKGROUND Target therapy is licensed by United States Food and Drug Administration on certain cancers.Both sorafenib and lenvatinib are tyrosine kinase inhibitor and indicated on radioactive iodine(RAI)-refractory differentiated thyroid cancer(DTC).Lenvatinib is more effective in cancers'control than sorafenib,but causes more nephrotoxicity than sorafenib does.This case is the second published case about the serial adaptions from lenvatinib to sorafenib for improving the proteinuria and,meanwhile,achieving the therapeutic goal.CASE SUMMARY A 56-year-old man suffered from bilateral edematous lower extremities after 1-mo prescription of lenvatinib of 20 mg/d for RAI-refractory DTC.Aside from this symptom,he also developed hypertension.His laboratory showed grade-3 proteinuria(estimated 24-h urine protein:9993 mg),hypoalbuminemia and hypercholesterolemia.Anti-vascular endothelial growth factor(VEGF)therapyinduced nephrotic syndrome was impressed.After reduced dosage of lenvatinib of 10 mg/d and related symptomatic drugs,limited improvement was observed in both adverse effects and caner control.Under this condition,we substituted sorafenib of 400 mg/d for lenvatinib of 10 mg/d.After a 5-mo prescription,not only hypertension and peripheral edema were greatly improved,but also proteinuria was improved from grade three to grade one(estimated 24-h urine protein:962 mg).At the same time the cancer control was achieved,judged from computed tomography and laboratory evidence[thyroglobulin(Tg)before prescription of sorafenib:354.7 ng/m L;Tg after prescription of sorafenib:108.9 ng/m L].CONCLUSION Adaption from lenvatinib to sorafenib is a feasible method to improve the antiVEGF therapy-induced nephrotic syndrome and achieve the therapeutic goal at the same time.

Effect of music therapy derived from the five elements in Traditional Chinese Medicine on post-stroke depression

OBJECTIVE: To evaluate the clinical efficacy and safety of five phase music therapy in patients with depression after ischemic stroke.METHODS: A total of 92 patients with post-stroke depression were randomly divided into the control group(32 cases), treatment group A(30 cases), and treatment group B(30 cases). All groups were given basic therapies for cerebral infarction. In addition,the control group was administerd 50 mg of oral sertraline hydrochloride daily, while treatment groups A and B received needling at Baihui(GV 20)plus acupoint injection at Yanglingquan(GB 34) daily; treatment group B also received music therapy derived from the five phases in Traditional ChineseMedicine theory twice daily. All treatments were administered for 5 d per treatment cycle for three cycles, with a 1 d interval between cycles. In all three groups, Hamilton's depression scale(HAMD-17)score and the activities of daily life(ADL) score were measured before and after treatment, and side effects were assessed with the treatment emergent symptom scale.RESULTS: The HAMD-17 score significantly decreased after treatment in all three groups, and the post-treatment reduction in HAMD-17 score was markedly greater in treatment group B than in treatment group A(P < 0.01). The ADL score significantly increased after treatment in all three groups,and the post-treatment increase in ADL score was significantly greater in treatment group B than in treatment group A(P < 0.01). The treatment emergent symptom scale score was highest in the control group, and lowest in group B, and significantly differed between the three groups(P < 0.01).CONCLUSION: Five phase music therapy plus acupoint needling and acupoint injection can improve the symptoms in patients with post-stroke depression.