Lenvima (Lenvatinib)

Lenvima acts on multiple signalling pathways that drive tumour growth and angiogenesis, making it useful in several cancer types.

• Differentiated thyroid cancer: inhibits tumour progression in patients with radioactive iodine‑refractory disease.
• Renal cell carcinoma: slows disease advancement in advanced clear‑cell renal carcinoma.
• Hepatocellular carcinoma: reduces tumour burden in unresectable liver cancer.
• Endometrial carcinoma: improves progression‑free survival in advanced endometrial cancer.

• Lenvatinib blocks a spectrum of receptor tyrosine kinases—including VEGFR1‑3, FGFR1‑4, PDGFRα, RET and KIT—thereby suppressing angiogenesis, tumour cell proliferation and survival pathways. This multi‑target inhibition disrupts the vascular supply and growth signals that cancers rely on, leading to reduced tumour growth.

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

Common Side Effects

• Hypertension: elevated blood pressure requiring monitoring.
• Diarrhoea: watery stools that may be mild to moderate.
• Fatigue: persistent tiredness affecting daily activities.
• Nausea: feeling of sickness often managed with anti‑emetics.
• Decreased appetite: reduced desire to eat, potentially leading to weight loss.
• Proteinuria: presence of protein in urine detected on lab tests.

Serious or Rare Side Effects

• Hepatic failure: severe liver injury requiring immediate medical attention.
• Arterial thromboembolic events: blood clots that can cause stroke or heart attack.
• Severe haemorrhage: uncontrolled bleeding, especially gastrointestinal.
• Gastro‑intestinal perforation or fistula formation.
• Cardiac dysfunction: reduced heart pumping ability or arrhythmias.
• Renal impairment: significant decline in kidney function.

Before initiating Lenvima, several safety considerations should be addressed.

• Blood pressure monitoring: check regularly because hypertension is common.
• Liver function tests: assess baseline and periodic labs to detect hepatic toxicity.
• Renal function assessment: evaluate kidney health, especially in patients with pre‑existing impairment.
• Pregnancy and lactation: avoid use unless benefits outweigh potential fetal risks; discuss with a specialist.
• Drug‑specific contraindications: do not use in patients with known hypersensitivity to lenvatinib.
• Store at ambient temperature below 25°C: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

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

Moderate Interactions (Monitor Closely)

• Diuretics: may exacerbate hypertension or electrolyte disturbances.
• Other anti‑angiogenic agents: additive risk of vascular events.
• CYP3A4 substrates with narrow therapeutic index (e.g., tacrolimus): monitor plasma concentrations.