Lenvatinib

Lenvatinib Brand Name– LENVIMA

What is Lenvatinib

Lenvatinib is an oral kinase inhibitor against vascular endothelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4).

It also inhibits other kinases that have been implicated in angiogenesis, tumor growth, and cancer progression including fibroblast growth factor (FGF) receptors 1, 2, 3, and 4, as well as platelet derived growth factor receptor (PDGFR) alpha, KIT, and RET.

Lenvatinib is FDA approved for the treatment of advanced endometrial cancer, metastatic, radioactive iodine-refractory differentiated thyroid cancer, advanced renal cell carcinoma, and unresectable hepatocellular carcinoma. It may cause QT prolongation and should be avoided with other medications that cause QT prolongation.

Indications

  • endometrial cancer
  • hepatocellular cancer
  • renal cell cancer
  • thyroid cancer

For the treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC)

Side Effects

  1. abdominal pain
  2. abdominal pain
  3. adrenocortical insufficiency
  4. alopecia
  5. anemia
  6. anorexia
  7. anorexia
  8. arthralgia
  9. arthralgia
  10. ascites
  11. ascites
  12. asthenia
  13. back pain
  14. bleeding
  15. bleeding
  16. cardiomyopathy
  17. cholecystitis
  18. coma
  19. confusion
  20. constipation
  21. constipation
  22. cough
  23. cystitis
  24. dehydration
  25. dehydration
  26. diarrhea
  27. diarrhea
  28. dizziness
  29. dizziness
  30. dysgeusia
  31. dyspepsia
  32. dyspepsia
  33. dysphonia
  34. dysphonia
  35. dyspnea
  36. dyspnea
  37. elevated hepatic enzymes
  38. encephalopathy
  39. epistaxis
  40. erythema
  41. exfoliative dermatitis
  42. fatigue
  43. fatigue
  44. fever
  45. fever
  46. gastroesophageal reflux
  47. GI bleeding
  48. GI perforation
  49. gingivitis
  50. glossitis
  51. headache
  52. headache
  53. heart failure
  54. hematemesis
  55. hematoma
  56. hematuria
  57. hemoptysis
  58. hepatic encephalopathy
  59. hepatic encephalopathy
  60. hepatic failure
  61. hepatitis
  62. hepatotoxicity
  63. hyperamylasemia
  64. hyperbilirubinemia
  65. hypercalcemia
  66. hypercholesterolemia
  67. hypercholesterolemia
  68. hyperglycemia
  69. hyperkalemia
  70. hyperkalemia
  71. hyperkeratosis
  72. hypermagnesemia
  73. hypertension
  74. hypertension
  75. hypertensive crisis
  76. hypertriglyceridemia
  77. hypoalbuminemia
  78. hypoalbuminemia
  79. hypocalcemia
  80. hypoglycemia
  81. hypokalemia
  82. hypomagnesemia
  83. hyponatremia
  84. hypophosphatemia
  85. hypotension
  86. hypotension
  87. hypothyroidism
  88. impaired wound healing
  89. infection
  90. infection
  91. insomnia
  92. insomnia
  93. intracranial bleeding
  94. lethargy
  95. leukoencephalopathy
  96. leukopenia
  97. lymphopenia
  98. maculopapular rash
  99. malaise
  100. musculoskeletal pain
  101. myalgia
  102. myalgia
  103. myocardial infarction
  104. nausea
  105. nausea
  106. nephrotic syndrome
  107. neutropenia
  108. oral ulceration
  109. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  110. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  111. pancreatitis
  112. parotitis
  113. peripheral edema
  114. peripheral edema
  115. pleural effusion
  116. prolonged bleeding time
  117. prolonged bleeding time
  118. proteinuria
  119. proteinuria
  120. pulmonary embolism
  121. QT prolongation
  122. QT prolongation
  123. rash
  124. rash
  125. renal failure (unspecified)
  126. renal failure (unspecified)
  127. stomatitis
  128. stomatitis
  129. stroke
  130. thrombocytopenia
  131. thromboembolism
  132. thrombosis
  133. vomiting
  134. vomiting
  135. weakness
  136. weight loss
  137. weight loss
  138. wound dehiscence
  139. xerostomia
  140. xerostomia

Monitoring Parameters

  • blood pressure
  • ECG
  • LFTs
  • pregnancy testing
  • serum calcium
  • serum creatinine/BUN
  • serum electrolytes
  • thyroid function tests (TFTs)
  • urinalysis

Contraindications

  • apheresis
  • AV block
  • bleeding
  • bradycardia
  • breast-feeding
  • cardiac disease
  • cardiomyopathy
  • celiac disease
  • contraception requirements
  • coronary artery disease
  • dehydration
  • electrolyte imbalance
  • encephalopathy
  • females
  • fever
  • fistula
  • geriatric
  • GI perforation
  • heart failure
  • hepatic disease
  • hepatotoxicity
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hypertension
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothermia
  • hypothyroidism
  • hypovolemia
  • impaired wound healing
  • infertility
  • long QT syndrome
  • myocardial infarction
  • pheochromocytoma
  • pregnancy
  • pregnancy testing
  • proteinuria
  • QT prolongation
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • rheumatoid arthritis
  • sickle cell disease
  • sleep deprivation
  • stroke
  • surgery
  • systemic lupus erythematosus (SLE)
  • thromboembolic disease
  • thyroid cancer
  • thyroid disease

Interactions

  • Aclidinium; Formoterol
  • Albuterol
  • Albuterol; Ipratropium
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Anagrelide
  • Apomorphine
  • Arformoterol
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether; Lumefantrine
  • Asenapine
  • Atomoxetine
  • Azithromycin
  • Bedaquiline
  • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Ciprofloxacin
  • Cisapride
  • Citalopram
  • Clarithromycin
  • Clofazimine
  • Clomipramine
  • Clozapine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Crizotinib
  • Dasatinib
  • Degarelix
  • Desipramine
  • Deutetrabenazine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Dolutegravir; Rilpivirine
  • Donepezil
  • Donepezil; Memantine
  • Doxepin
  • Dronedarone
  • Droperidol
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Eliglustat
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Encorafenib
  • Entrectinib
  • Eribulin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Escitalopram
  • Ezogabine
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluphenazine
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • Formoterol
  • Formoterol; Mometasone
  • Foscarnet
  • Gemifloxacin
  • Gemtuzumab Ozogamicin
  • Gilteritinib
  • Glasdegib
  • Glycopyrrolate; Formoterol
  • Goserelin
  • Granisetron
  • Halogenated Anesthetics
  • Haloperidol
  • Histrelin
  • Hydroxychloroquine
  • Hydroxyzine
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Inotuzumab Ozogamicin
  • Itraconazole
  • Ivosidenib
  • Ketoconazole
  • Lapatinib
  • Lefamulin
  • Leuprolide
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levofloxacin
  • Lithium
  • Lofexidine
  • Long-acting beta-agonists
  • Loperamide
  • Loperamide; Simethicone
  • Lopinavir; Ritonavir
  • Macimorelin
  • Maprotiline
  • Mefloquine
  • Meperidine; Promethazine
  • Metaproterenol
  • Methadone
  • Metronidazole
  • Midostaurin
  • Mifepristone
  • Mirtazapine
  • Moxifloxacin
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Olanzapine
  • Olodaterol
  • Ondansetron
  • Osilodrostat
  • Osimertinib
  • Oxaliplatin
  • Ozanimod
  • Paliperidone
  • Panobinostat
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenylephrine; Promethazine
  • Pimavanserin
  • Pimozide
  • Pirbuterol
  • Pitolisant
  • Posaconazole
  • Primaquine
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rilpivirine
  • Risperidone
  • Romidepsin
  • Salmeterol
  • Saquinavir
  • Selpercatinib
  • Sertraline
  • Short-acting beta-agonists
  • Siponimod
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telavancin
  • Telithromycin
  • Terbutaline
  • Tetrabenazine
  • Thioridazine
  • Tiotropium; Olodaterol
  • Tolterodine
  • Toremifene
  • Trazodone
  • Triclabendazole
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Umeclidinium; Vilanterol
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Voriconazole
  • Vorinostat
  • Ziprasidone