LENVATINIB
Background and Date of Approval
Lenvatinib is a tyrosine kinase inhibitor containing lenvatinib as the active ingredient. It is indicated for progressive or advanced thyroid cancer when radioactive iodine therapy has not been effective. It is also used to treat previously untreated hepatocellular carcinoma in patients who are not candidates for surgical intervention. Patients with a history of allergic reaction to lenvatinib or any of its components should not use this medication. Patients must inform their dentist or oral surgeon of lenvatinib use, as the drug can impair wound healing and increase bleeding risk. Lenvatinib received approval from the United States Food and Drug Administration (FDA) in February 2015 for locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer. Subsequent approvals have extended its use to hepatocellular carcinoma (liver cancer) and renal cell carcinoma (kidney cancer).
Uses
Lenvatinib is a medication that is used to treat several types of cancer, including thyroid, liver, and kidney cancer. In patients with radioactive iodine-refractory differentiated thyroid cancer, it can be used to slow the progression of the disease and reduce tumor size. It is also approved for the treatment of unresectable hepatocellular carcinoma (HCC), which is the most common type of liver cancer.
How is it administered?
Lenvatinib is an oral medication that is usually taken once a day, at approximately the same time each day, with or without food. It should be taken as prescribed by a doctor or other healthcare provider. These capsules should be swallowed whole with a glass of water. They should not be crushed, chewed, or opened, as this can affect the way the medication is absorbed and decrease its effectiveness. You should not take a double dose to make up the second dose.
Side Effects
Lenvatinib can cause several side effects, some of which can be serious. Common side effects include fatigue, decreased appetite, weight loss, muscle pain, nausea, vomiting, and diarrhea. Patients may also experience high blood pressure. Other potential side effects include liver damage, blood clotting problems, and heart problems. Patients should be monitored closely for signs of liver damage, such as yellowing of the skin or eyes, dark urine, or abdominal pain. It can also increase the risk of blood clots, which can be life-threatening. This medication can cause serious heart problems, including heart attack, stroke, and heart failure.
Warnings
Lenvatinib can cause an increase in blood pressure and increase the risk of heart attack, stroke, and other cardiovascular events. This medication can increase the risk of bleeding or hemorrhage and impair wound healing. It can cause kidney damage or kidney failure which results in proteinuria (an abnormal amount of protein in the urine). Sometimes it can cause hypothyroidism or other thyroid dysfunction. In rare cases, this medication can cause a condition called reversible posterior leukoencephalopathy syndrome (RPLS), which can cause seizures, confusion, and other neurological symptoms.
Precautions
Patients taking lenvatinib should monitor their blood pressure regularly, and if hypertension is not well-controlled, the dose needs to be adjusted or treatment may need to be stopped. Patients with a history of cardiovascular disease, history of bleeding, or taking blood thinners require close monitoring. Patients should inform their healthcare provider if they plan to have any surgical procedures during treatment as this medication increases the risk of bleeding. You should do urine tests regularly for protein checks and any signs of kidney problems while taking this medication. Women of reproductive age should use effective contraception while taking it and for at least one week after the last dose. You should do thyroid function testing regularly while taking and if there are signs of thyroid dysfunction tell your doctor immediately.
Word of Advice
Maintain regular communication with your doctor and report any concerns or side effects promptly. Avoid pregnancy and breastfeeding during treatment. Do not consume grapefruits as they may affect the absorption of lenvatinib. Use sunscreen and wear protective clothing when outdoors to reduce the risk of sunburn or skin damage. Avoid strenuous activities or exercise until you understand how this medication affects you. Eat a healthy and balanced diet during treatment to support your overall health and well-being. By remaining informed and engaged in your treatment plan, you can help ensure optimal outcomes and manage any potential risks or complications.
References
Eisai Europe Limited, Electronic Medicines Compendium (EMC), [Revised on Mar 2021] [Accessed on 20th April 2023], https://www.medicines.org.uk/emc/files/pil.6840.pdf Suyama and Iwase, Lenvatinib: A promising molecular targeted agent for multiple cancers, Cancer Control, 2018, 25, 1-5, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056795/pdf/10/1177 1073274818789361.pdf Q.M. Anstee, D.E.J. Jones, Liver and Biliary Tract Disease, Davidsonâs Principles and Practice of Medicine, 22nd Edition, 2014, 921-988. M.W.J. Strachan, J. Newell-Price, Endocrine disease, Davidsonâs Principles & Practice of Medicine, 22nd Edition, 2014, 733-796. Eisai Inc U.S Food and Safety Drug Administration (FDA) [Last revised Aug 2018], [Accessed on 20th April 2023], https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/206947s007lbl.pdf
Frequently Asked Questions
Can lenvatinib cause infertility?
Lenvatinib can cause changes in menstrual periods and may affect fertility in some women. Patients should discuss their fertility concerns with their healthcare provider before starting this medication.
Can lenvatinib cause hair loss?
Yes, hair loss is a potential side effect of lenvatinib. However, not all patients experience hair loss while taking this medication. Patients should discuss the potential side effects with their healthcare provider before starting treatment.
Can lenvatinib cause heart problems?
Lenvatinib can cause high blood pressure, which may increase the risk of heart problems. Patients should have their blood pressure monitored regularly while taking this medication.
Can I go for a teeth extraction if I am taking Lenvatinib?
Before undergoing any dental procedures, it's important to inform your dentist and healthcare provider that you are taking lenvatinib. It can increase the risk of bleeding, and dental procedures that involve cutting or removing tissue may increase this risk further. Your healthcare provider and the dentist may recommend taking certain precautions, such as temporarily stopping of this medication before the procedure or adjusting your medication dose.
Can lenvatinib cause vision problems?
Yes, vision problems are a potential side effect of lenvatinib. Patients should report any changes in vision to their healthcare provider immediately.
Can lenvatinib be used in children?
Lenvatinib is not currently approved for use in children. The safety and efficacy in children have not been established.