Lenvima (Lenvatinib)

• Lenvima (lenvatinib) is used in oncology to target tumors that rely on multiple growth‑factor pathways.
• Radioiodine‑refractory differentiated thyroid cancer: prolongs progression‑free survival in adult patients.
• Advanced renal cell carcinoma: improves overall survival when used alone or with pembrolizumab.
• Unresectable hepatocellular carcinoma: delays tumor growth in patients not eligible for surgery.
• Advanced endometrial carcinoma: provides disease control after prior systemic therapy.

• Lenvatinib inhibits multiple receptor tyrosine kinases—including VEGFR1‑3, FGFR1‑4, PDGFRα, RET and KIT—thereby blocking angiogenesis, tumor cell proliferation, and survival signaling pathways that drive cancer growth.

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

Common Side Effects

• Hypertension: elevated blood pressure often requiring monitoring or medication.
• Diarrhea: watery stools that may lead to dehydration.
• Fatigue: persistent tiredness affecting daily activities.
• Decreased appetite: reduced desire to eat, potentially causing weight loss.

Serious or Rare Side Effects

• Hepatic failure: signs of liver dysfunction such as jaundice or elevated enzymes.
• Cardiac ischemia: chest pain or heart‑attack symptoms.
• Gastrointestinal perforation: severe abdominal pain and infection risk.
• Severe hemorrhage: uncontrolled bleeding, including nosebleeds or gastrointestinal bleeding.

Before initiating therapy, clinicians should evaluate several safety parameters.

• Blood pressure monitoring: check regularly and manage hypertension promptly.
• Liver function tests: assess baseline and periodic hepatic enzymes.
• Cardiac evaluation: perform ECG and assess for ischemic disease before starting.
• Pregnancy risk: avoid use in pregnancy; drug is Category D.
• Drug interactions: review concomitant medications for CYP3A4 substrates.
• Store at ambient temperature: keep below 25°C in original packaging, protect from moisture.

Lenvima interacts with several medicines; some combinations should be avoided while others require close observation.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce lenvatinib exposure.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): increased risk of bleeding.
• High‑dose aspirin or NSAIDs: may exacerbate bleeding risk.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., fluconazole, erythromycin): may increase plasma levels.
• Diuretics: may potentiate hypertension.
• Levothyroxine: may require dose adjustment due to altered thyroid hormone metabolism.