Lenvatinib Sandoz (Lenvatinib)

Lenvatinib is a tyrosine kinase inhibitor used in oncology to block angiogenesis and tumor growth.

• Differentiated thyroid carcinoma: improves progression‑free survival in patients with radioactive‑iodine‑refractory disease.
• Renal cell carcinoma: reduces tumor burden and extends overall survival in advanced clear‑cell RCC.
• Hepatocellular carcinoma: delays disease progression in patients with unresectable HCC.

• Lenvatinib inhibits multiple receptor tyrosine kinases—including VEGFR1‑3, FGFR1‑4, PDGFRα, RET and KIT—thereby suppressing angiogenic signaling pathways, reducing tumor vascularization, and limiting cancer cell proliferation and survival.

Lenvatinib may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Hypertension: elevated blood pressure requiring monitoring.
• Diarrhea: watery stools that may lead to dehydration.
• Fatigue: persistent tiredness affecting daily activities.
• Decreased appetite: reduced desire to eat, potentially causing weight loss.
• Nausea: upset stomach that can be mild to moderate.
• Weight loss: unintended loss of body weight.

Serious or Rare Side Effects

• Hepatic failure: severe liver injury requiring immediate medical attention.
• Arterial thromboembolism: blood clot formation in arteries.
• Severe hemorrhage: uncontrolled bleeding, especially gastrointestinal.
• Gastrointestinal perforation or fistula: serious gut wall injury.
• Severe infection: opportunistic infections due to immune modulation.
• Cardiac dysfunction: heart failure or reduced ejection fraction.

Before initiating therapy, clinicians should evaluate baseline health status and monitor patients regularly.

• Blood pressure monitoring: check and control hypertension throughout treatment.
• Liver function assessment: perform baseline and periodic liver enzyme tests.
• Proteinuria screening: test urine for protein to detect renal effects.
• Anticoagulant review: assess bleeding risk when used with anticoagulants.
• Drug interaction check: evaluate concomitant medications for CYP3A4 effects.
• Store at ambient temperature: keep in original container, protect from moisture and direct sunlight.

Lenvatinib has a potential for pharmacokinetic and pharmacodynamic interactions that may require dose adjustment or avoidance.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): increase lenvatinib exposure.
• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): decrease lenvatinib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): raise bleeding risk.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may potentiate blood pressure changes.
• Diuretics: can affect electrolyte balance and renal function.
• Other anti‑angiogenic agents: additive risk of hypertension and vascular events.
• Immunosuppressants (e.g., cyclosporine): possible altered metabolism.
• QT‑prolonging drugs: monitor cardiac rhythm for arrhythmias.