Neoadjuvant Lenvatinib in a Locally Invasive Hobnail Variant Papillary Thyroid Cancer Enabling Surgical Resection

A 64-year-old man presented with a 7 cm papillary thyroid cancer (PTC) and suspicion of diffuse lung metastases. Thyroidectomy was attempted, but his tumour was deemed unresectable due to gross invasion into surrounding neck structures. After institutional tumour board discussion, he was started on neoadjuvant lenvatinib therapy with the goal of enabling surgical resection. The tumour decreased in size from 6.2 x 3.3 cm at baseline to 3.1 x 2.1 cm after 3 months on therapy. Lenvatinib treatment was complicated by grade 1 diarrhea, rash and hypertension; he also developed acute cholecystitis, which was surgically treated.