Lenvatinib (LENVIMA)

Hepatocellular carcinoma, advanced

Thyroid cancer, recurrent or metastatic

Endometrial carcinoma, advanced or metastatic

Renal cell carcinoma, advanced or metastatic

Hepatocellular carcinoma, advanced

• Dose – Oral: In patients ≥60 kg: 12 mg once daily continuously until disease progression or unacceptable toxicity
• Dose – Oral: In patients <60 kg: 8 mg once daily continuously until disease progression or unacceptable toxicity

Thyroid cancer, recurrent or metastatic

• Dose – Oral: 24 mg once daily continuously until disease progression or unacceptable toxicity

Endometrial carcinoma, advanced or metastatic

• Dose – Oral: 20 mg once daily continuously until disease progression or unacceptable toxicity
• Given in combination with pembrolizumab

Renal cell carcinoma, advanced or metastatic

• Dose – Oral: 20 mg once daily continuously until disease progression or unacceptable toxicity
• Given in combination with pembrolizumab

Available as 4 mg and 10 mg hard hypromellose capsules. An oral suspension may be compounded for patients unable to swallow the capsules, please discuss with your pharmacy team. Store at room temperature.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a VEGF (vascular endothelial growth factor) inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Diarrhea, Nausea, Vomiting, Weight loss, Anorexia, Proteinuria, Hemorrhage, Hypertension.

Less Common: Arterial thromboembolic event, Cardiac failure, Gastrointestinal perforation or fistula, Hepatic failure, Left ventricular ejection fraction decrease, QT prolongation, Renal impairment, Epistaxis, Osteonecrosis of the jaw.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, sodium, potassium, magnesium, calcium, albumin, bilirubin, ALT, alkaline phosphatase, GGT, TSH, urinalysis, INR, blood pressure measurement, ECG. If clinically indicated: AFP.

Every two weeks for first 2 months during treatment: blood pressure, ALT, alkaline phosphatase, bilirubin, albumin.

During treatment: CBC & differential and platelets, creatinine, sodium, potassium, magnesium, calcium, albumin, bilirubin, ALT, alkaline phosphatase, urine protein, TSH, blood pressure.

If clinically indicated: routine ECG to monitor for QT, MUGA scan or echocardiogram.

Note: Additional monitoring is required for pembrolizumab if being used in combination.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Patients on IV bisphosphonates are at higher risk of osteonecrosis of the jaw.
• Hypertension is common with VEGF inhibitors. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions. Hypertension should be well controlled prior to starting lenvatinib.
• Thyroid dysfunction, in particular hypothyroidism, may occur with this treatment. Monitor for signs and symptoms of thyroid dysfunction and manage as clinically appropriate.
• Proteinuria is a common side effect. Dipstick urinalysis is recommended for monitoring throughout treatment.
• Impaired wound healing is associated with VEGF inhibitors, drug may need to be held and restarted if patient requires surgery, discuss with team.

BC Cancer. BC Cancer Drug Manual. Lenvatinib. Vancouver, British Columbia: BC Cancer Agency. Available at :http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Lenvatinib_monograph.pdf. Updated January 1, 2024. Accessed 22 Jan 2024.

Lexicomp. Lenvatinib  Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/5536950?cesid=a8eDG1w08dv&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dlenvatinib%26t%3Dname%26acs%3Dtrue%26acq%3Dlenvatinib. Updated January 24, 2024. Accessed January 25, 2024.

Cancer Care Ontario. Lenvatinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44441. Updated September 2023. Accessed January 22, 2024.

Eisai Limited. LENVIMA® Product Monograph. Mississauga, Ontario: Eisai Limited. Updated July 19, 2023.