Lenvima (Lenvatinib)

Lenvima (lenvatinib) is used in oncology to target tumors driven by angiogenic and proliferative pathways.

• Radioiodine‑refractory differentiated thyroid cancer: improves progression‑free survival in patients whose disease no longer responds to radioactive iodine.
• Advanced renal cell carcinoma: provides disease control in adults with metastatic clear‑cell RCC who have received prior therapy.
• Unresectable hepatocellular carcinoma: extends overall survival in patients with liver cancer not amenable to surgery or locoregional treatment.

• Lenvatinib inhibits multiple receptor tyrosine kinases, including VEGFR1‑3, FGFR1‑4, PDGFRα, RET and KIT. By blocking these signaling pathways, it reduces tumor angiogenesis, impedes fibroblast growth factor–mediated proliferation, and interferes with downstream oncogenic signals, resulting in anti‑angiogenic and antiproliferative activity against malignant cells.

Lenvima may cause a range of adverse reactions, which are generally categorized by frequency and severity.

Common Side Effects

• Hypertension: elevated blood pressure often requiring monitoring or medication.
• Diarrhea: mild to moderate gastrointestinal upset.
• Fatigue: persistent tiredness affecting daily activities.
• Decreased appetite: reduced food intake and possible weight loss.
• Nausea: occasional feeling of sickness.
• Proteinuria: presence of protein in urine detected on lab tests.

Serious or Rare Side Effects

• Hepatotoxicity: liver enzyme elevations or liver injury.
• Cardiac dysfunction: reduced left ventricular ejection fraction or heart failure.
• Hemorrhage: severe bleeding events, including gastrointestinal or intracranial.
• Thromboembolic events: arterial or venous clot formation.
• Gastrointestinal perforation: rare but serious bowel wall breach.
• Severe infections: opportunistic or bacterial infections requiring treatment.

Before initiating Lenvima, clinicians should consider several safety precautions to minimize risks.

• Blood pressure monitoring: check baseline and regularly during therapy.
• Liver function tests: assess hepatic enzymes before and throughout treatment.
• Cardiac assessment: evaluate heart function, especially in patients with prior cardiac disease.
• Proteinuria screening: perform urine analysis at baseline and periodically.
• Pregnancy and lactation: avoid use in pregnant or breastfeeding women unless benefits outweigh risks.
• Store at ambient temperature: keep tablets below 25 °C in the original container, protected from moisture and light.

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

Major Interactions (Avoid)

• Strong CYP3A4 inducers: drugs such as rifampicin or carbamazepine may markedly reduce lenvatinib exposure.
• Anticoagulants/antiplatelet agents: concurrent use can increase risk of severe bleeding.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors: agents like ketoconazole may raise lenvatinib plasma levels.
• NSAIDs and aspirin: may enhance bleeding tendency.
• Diuretics: can exacerbate hypertension when combined with lenvatinib.
• Hormonal contraceptives: may have reduced effectiveness; consider alternative contraception.