Lenvima (Lenvatinib)

Lenvima is a multi‑targeted tyrosine kinase inhibitor used in several solid‑tumour indications.

• Radioiodine‑refractory differentiated thyroid cancer: slows disease progression and improves progression‑free survival.
• Hepatocellular carcinoma: provides an oral systemic option for patients not amenable to curative therapies.
• Renal cell carcinoma: used as first‑line or subsequent therapy to inhibit tumour angiogenesis.
• Advanced endometrial carcinoma: offers a targeted treatment for patients with disease that has progressed after prior therapy.

• Lenvatinib inhibits multiple receptor tyrosine kinases—including VEGFR1‑3, FGFR1‑4, PDGFRα, RET and KIT—thereby blocking signalling pathways that drive angiogenesis, tumour cell proliferation and survival. This multi‑kinase blockade reduces new blood‑vessel formation and directly suppresses cancer cell growth, contributing to antitumour activity across several malignancies.

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

Common Side Effects

• Hypertension: elevated blood pressure requiring monitoring and possible antihypertensive therapy.
• Diarrhoea: may be mild to moderate, often manageable with supportive care.
• Fatigue: persistent tiredness that can affect daily activities.
• Decreased appetite: reduced food intake leading to weight loss.
• Nausea: occasional upset stomach, may improve with anti‑emetics.

Serious or Rare Side Effects

• Hepatic failure: signs of liver dysfunction such as jaundice or elevated enzymes.
• Severe haemorrhage: gastrointestinal or intracranial bleeding events.
• Arterial thromboembolism: risk of stroke or myocardial infarction.
• Gastro‑intestinal perforation or fistula formation.
• Cardiac failure: new or worsening heart failure symptoms.
• Proteinuria: significant urinary protein loss indicating renal involvement.

Before initiating Lenvima, clinicians should assess baseline health status and monitor for specific risks.

• Monitor blood pressure: check regularly and treat hypertension promptly.
• Assess liver function: obtain baseline labs and repeat during therapy.
• Evaluate for proteinuria: perform urine dipstick tests periodically.
• Avoid use in pregnancy: drug is contraindicated and classified as Category X.
• Discontinue if severe adverse events occur: follow prescriber guidance for dose interruption or cessation.
• Store at below 25°C: keep in the original pack, protect from moisture.

Lenvima can interact with other medicines that affect its metabolism or increase bleeding risk.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may raise lenvatinib exposure.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce therapeutic levels.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): increase risk of serious bleeding.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents: blood‑pressure control may need adjustment.
• Diuretics: can exacerbate electrolyte disturbances.
• Other anti‑angiogenic drugs: additive toxicity, especially hypertension and proteinuria.