Lenvatinib Accord (Lenvatinib)

Lenvatinib is a tyrosine kinase inhibitor used in oncology to target tumor angiogenesis and cell proliferation.

• Differentiated thyroid cancer: improves progression‑free survival and disease control in patients with radioactive iodine‑refractory disease.
• Renal cell carcinoma: delays tumor growth and extends progression‑free survival in adults with advanced clear‑cell renal cell carcinoma.
• Hepatocellular carcinoma: prolongs overall survival and reduces tumor burden in patients with unresectable or metastatic hepatocellular carcinoma.

• Lenvatinib inhibits multiple receptor tyrosine kinases, including VEGFR1‑3, FGFR1‑4, PDGFRα, KIT and RET. By blocking these pathways, it reduces angiogenesis, tumor vascular development, and downstream proliferative signaling, leading to decreased tumor growth and metastasis. The drug binds competitively to the ATP‑binding pocket of these kinases, preventing autophosphorylation and subsequent activation of downstream MAPK and PI3K‑AKT pathways that drive cell proliferation and survival.

Lenvatinib may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Hypertension: elevated blood pressure often requiring antihypertensive therapy.
• Diarrhea: watery stools that may lead to dehydration.
• Fatigue: persistent tiredness affecting daily activities.
• Nausea: feeling of sickness that may reduce appetite.

Serious or Rare Side Effects

• Hepatotoxicity: elevated liver enzymes or liver failure requiring monitoring.
• Cardiac dysfunction: decreased left ventricular ejection fraction or heart failure.
• Thromboembolic events: blood clots such as deep vein thrombosis or pulmonary embolism.
• Severe hemorrhage: bleeding requiring medical intervention.

Before initiating Lenvatinib therapy, several precautions should be considered to ensure patient safety.

• Blood pressure monitoring: check baseline and regularly during treatment.
• Liver function assessment: evaluate hepatic enzymes before and during therapy.
• Cardiac evaluation: perform baseline ECG or echocardiogram in patients with cardiac risk.
• Pregnancy avoidance: drug is contraindicated in pregnancy; effective contraception required.
• Drug interactions: review concomitant medications for potential CYP3A4 interactions.
• Store at ambient temperature: keep below 25 °C in original container, protect from moisture and light.

Lenvatinib can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inducers: agents such as rifampin may markedly reduce plasma concentrations.
• Anticoagulants: concurrent use may increase risk of severe bleeding.
• High‑dose NSAIDs: can exacerbate hypertension and renal toxicity.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors: ketoconazole or clarithromycin may raise lenvatinib levels.
• Diuretics: may potentiate electrolyte disturbances and hypertension.
• Hormonal contraceptives: efficacy may be reduced; alternative contraception advised.