TY - JOUR
T1 - Managing the adverse events associated with lenvatinib therapy in radioiodine-refractory differentiated thyroid cancer
AU - Cabanillas, Maria E.
AU - Takahashi, Shunji
N1 - Publisher Copyright:
© 2018 The Authors
PY - 2019/2
Y1 - 2019/2
N2 - Lenvatinib is a multikinase inhibitor of vascular endothelial growth factor (VEGF) receptors 1–3, fibroblast growth factor receptors 1–4, RET, KIT, and platelet-derived growth factor receptor-α. Lenvatinib is approved as a monotherapy for the treatment of radioiodine-refractory differentiated thyroid cancer and in combination with everolimus for the second-line treatment of advanced renal cell carcinoma. Lenvatinib is also under investigation for the treatment of several malignancies including unresectable hepatocellular carcinoma. Although lenvatinib is associated with favorable efficacy, it is associated with adverse events (AEs) that the clinician will have to closely monitor for and proactively manage. Most of these AEs are known class effects of VEGF-targeted therapies, including hypertension, diarrhea, fatigue or asthenia, decreased appetite, and weight loss. This review summarizes the safety profile of lenvatinib and offers guidance for the management of both frequent and rare AEs. We discuss the potential mechanisms underlying these AEs and present practical recommendations for managing toxicities. The development of treatment plans that include prophylactic and therapeutic strategies for the management of lenvatinib-associated AEs has the potential to improve patient quality of life, optimize adherence, minimize the need for dose reductions, treatment interruptions, or discontinuations, and maximize patient outcomes.
AB - Lenvatinib is a multikinase inhibitor of vascular endothelial growth factor (VEGF) receptors 1–3, fibroblast growth factor receptors 1–4, RET, KIT, and platelet-derived growth factor receptor-α. Lenvatinib is approved as a monotherapy for the treatment of radioiodine-refractory differentiated thyroid cancer and in combination with everolimus for the second-line treatment of advanced renal cell carcinoma. Lenvatinib is also under investigation for the treatment of several malignancies including unresectable hepatocellular carcinoma. Although lenvatinib is associated with favorable efficacy, it is associated with adverse events (AEs) that the clinician will have to closely monitor for and proactively manage. Most of these AEs are known class effects of VEGF-targeted therapies, including hypertension, diarrhea, fatigue or asthenia, decreased appetite, and weight loss. This review summarizes the safety profile of lenvatinib and offers guidance for the management of both frequent and rare AEs. We discuss the potential mechanisms underlying these AEs and present practical recommendations for managing toxicities. The development of treatment plans that include prophylactic and therapeutic strategies for the management of lenvatinib-associated AEs has the potential to improve patient quality of life, optimize adherence, minimize the need for dose reductions, treatment interruptions, or discontinuations, and maximize patient outcomes.
KW - Adverse event
KW - Differentiated thyroid cancer
KW - Lenvatinib
KW - Side effect
KW - Tyrosine kinase inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85060288832&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060288832&partnerID=8YFLogxK
U2 - 10.1053/j.seminoncol.2018.11.004
DO - 10.1053/j.seminoncol.2018.11.004
M3 - Review article
C2 - 30685073
AN - SCOPUS:85060288832
SN - 0093-7754
VL - 46
SP - 57
EP - 64
JO - Seminars in oncology
JF - Seminars in oncology
IS - 1
ER -