Generic name: lenvatinib (len VA ti nib)
Brand name: Lenvima, Lenvima 8 mg daily-dose, Lenvima 20 mg daily-dose, Lenvima 12 mg daily-dose
Dosage forms: oral capsule (10 mg; 12 mg daily-dose; 14 mg daily-dose; 18 mg daily-dose; 20 mg daily-dose; 24 mg daily-dose; 4 mg; 8 mg daily-dose)
Drug class: Multikinase inhibitors, VEGF / VEGFR inhibitors
Lenvatinib is a kinase inhibitor used to treat certain types of cancer. Kinase inhibitors are enzyme inhibitors that blocks the action of one or more protein kinases.
Lenvatinib is used to treat thyroid cancer. It is usually given after radioactive iodine has been tried without success.
Lenvatinib is used together with everolimus (Afinitor) to treat advanced kidney cancer when other medicines have not been effective.
Lenvatinib is used together with pembrolizumab (Keytruda) to treat a certain type of endometrial cancer (a type of uterine cancer) that has progressed and cannot be removed with surgery or radiation.
Lenvatinib is also used to treat liver cancer that cannot be removed with surgery.
Warnings
Some people taking lenvatinib have developed a perforation (a hole or tear) or a fistula (an abnormal passageway) within the stomach or intestines. Get emergency medical help if you have severe stomach pain, or if you feel like you are choking and gagging when you eat or drink.
Call your doctor at once if you have signs of serious side effects, including: severe chest pain, shortness of breath, swelling in your ankles, numbness or weakness, confusion, severe headache, problems with speech or vision, seizure (convulsions), unusual bleeding, coughing up blood, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).
Before taking this medicine
To make sure lenvatinib is safe for you, tell your doctor if you have ever had:
- long QT syndrome (in you or a family member);
- heart disease, high blood pressure;
- a heart attack, heart failure, stroke, or blood clot;
- headaches or vision problems;
- bleeding problems;
- a perforation (a hole or tear) in your stomach or intestines;
- a seizure disorder;
- kidney disease; or
- liver disease.
Lenvatinib may cause jaw bone problems (osteonecrosis). The risk is highest in people with cancer, blood cell disorders, pre-existing dental problems, or people treated with steroids, chemotherapy, or radiation. Ask your doctor about your own risk.
Lenvatinib may harm an unborn baby. You may need to have a negative pregnancy test before starting this treatment. Use effective birth control to prevent pregnancy while you are using this medicine and for at least 30 days after your last dose.
Pregnancy may be less likely to occur while the mother or the father is using this medicine. Both men and women should still use birth control to prevent pregnancy because the medicine can harm an unborn baby.
Do not breastfeed while using this medicine, and for at least 1 week after your last dose.
How should I take lenvatinib?
Take lenvatinib exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Take lenvatinib at the same time each day, with or without food.
To get a full dose, you may need to take a combination of capsules with different amounts (strengths) of lenvatinib in them. Follow your doctor's dosing instructions very carefully.
Swallow the capsule whole and do not crush, chew, break, or open it.
If you cannot swallow a capsule whole, dissolve the capsules in water as follows:
- Measure 1 tablespoon of water or apple juice and pour the liquid into a small glass.
- Place only enough capsules for one dose into the liquid. Allow the capsules to dissolve for at least 10 minutes, then stir the mixture for at least 3 more minutes.
- Drink this mixture right away. Add a little more water or juice to the glass, swirl gently and drink right away.
Call your doctor if you are sick with vomiting or severe diarrhea. Prolonged illness can lead to dehydration and kidney failure.
Carefully follow your doctor's instructions about when to start taking medicine to prevent diarrhea while you are using lenvatinib.
You will need frequent medical tests and blood pressure checks.
Pay special attention to your dental hygiene while taking lenvatinib. Brush and floss your teeth regularly. If you need to have any dental work (especially surgery), tell the dentist ahead of time that you are using lenvatinib.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Use the medicine as soon as you can, but skip the missed dose if you are more than 12 hours late for the dose. Do not use two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking lenvatinib?
Follow your doctor's instructions about any restrictions on food, beverages, or activity.
Lenvatinib side effects
Get emergency medical help if you have signs of an allergic reaction to lenvatinib: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Some people taking lenvatinib have developed a perforation (a hole or tear) or a fistula (an abnormal passageway) within the stomach or intestines. Call your doctor if you have severe stomach pain, or if you feel like you are choking and gagging when you eat or drink.
Also call your doctor at once if you have:
- severe diarrhea;
- headache, confusion, change in mental status, vision loss, seizure (convulsions);
- little or no urination;
- unusual bleeding (nosebleeds, heavy menstrual bleeding), or any other bleeding that will not stop;
- severe headache, blurred vision, pounding in your neck or ears;
- jaw pain or numbness, red or swollen gums, loose teeth, or slow healing after dental work;
- signs of stomach bleeding - bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
- heart problems - chest pain, pain in your jaw or shoulder, swelling, rapid weight gain, feeling short of breath;
- signs of a blood clot - sudden numbness or weakness, problems with vision or speech;
- liver problems - dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
- low calcium level - muscle spasms or contractions, numbness or tingly feeling (around your mouth, or in your fingers and toes).
Your cancer treatments may be delayed or permanently discontinued if you have certain side effects.
Common lenvatinib side effects may include:
- bleeding;
- stomach pain, nausea, vomiting, diarrhea;
- loss of appetite, weight loss;
- abnormal thyroid function tests;
- muscle or joint pain;
- swelling in your arms and legs;
- mouth sores;
- rash;
- redness, itching, or peeling skin on your hands or feet;
- headache, tiredness; or
- cough, trouble breathing, hoarse voice.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Dosing information
Usual Adult Dose for Thyroid Cancer:
24 mg orally once a day
Comment:
-Treatment should be continued until disease progression or unacceptable toxicity.
Use: For the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC)
Usual Adult Dose for Renal Cell Carcinoma:
18 mg orally once a day
Comments:
-This drug is given in combination with 5 mg everolimus.
-Refer to everolimus prescribing information for recommended dosing information.
-Treatment should be continued until disease progression or unacceptable toxicity.
Use: In combination with everolimus for the treatment of patients with advanced renal cell carcinoma (RCC) following one prior anti-angiogenic therapy
Usual Adult Dose for Hepatocellular Carcinoma:
-Weight less than 60 kg: 8 mg orally once a day
-Weight 60 kg or greater: 12 mg orally once a day
Comment:
-Treatment should be continued until disease progression or unacceptable toxicity.
Use: For the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC)
Usual Adult Dose for Endometrial Carcinoma:
20 mg orally once daily
Comments:
-This drug is given in combination with pembrolizumab 200 mg IV over 30 minutes every 3 weeks.
-Refer to the pembrolizumab prescribing information for other dosing information.
-Treatment should be continued until disease progression or unacceptable toxicity.
Use: In combination with pembrolizumab for the treatment of patients with advanced endometrial carcinoma that is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), who have disease progression following prior systemic therapy and are not candidates for curative surgery or radiation
What other drugs will affect lenvatinib?
Lenvatinib can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.
Tell your doctor about all your other medicines, especially an osteoporosis medicine.
Other drugs may interact with lenvatinib, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.