What are the possible side effects of Lenvatinib? Detailed discussion on coping methods

Lenvatinib (also known as Lenvatinib) is a multi-target tyrosine kinase inhibitor (TKI) that mainly exerts anti-cancer effects by inhibiting the signaling pathways of tumor angiogenesis and tumor cell growth. The receptors it targets include VEGFR (vascular endothelial growth factor receptor) 1-3, FGFR (fibroblast growth factor receptor) 1-4, PDGFRα, RET and KIT, etc. It is a typical targeted therapy drug. Lenvatinib has been widely used to treat a variety of malignant tumors such as thyroid cancer, hepatocellular carcinoma, and renal cell carcinoma, especially showing good efficacy in the treatment of advanced tumors. However, during treatment, lenvatinib may cause a variety of side effects, some of which may even affect the continuity of treatment and patient quality of life. Therefore, the identification and management of its adverse reactions is crucial.
1. Common side effects and mechanisms
1. Hypertension
One of the most common adverse reactions of lenvatinib is hypertension, which has a high incidence and may increase rapidly especially in the early stages of treatment. This is due to its inhibition of the VEGF signaling pathway, which in turn affects the production of vasodilator factors (such as NO) and causes peripheral vasoconstriction.
Countermeasures: Blood pressure should be monitored before treatment and controlled within the normal range; blood pressure should be measured daily in the early stage of medication. If blood pressure rises, antihypertensive drugs (such as ACEI, ARB or calcium channel blockers) should be used promptly; treatment needs to be suspended or reduced in case of severe hypertension.
2. Proteinuria
Inhibiting VEGFR with lenvatinib will affect glomerular permeability, leading to proteinuria and even renal function damage. Moderate to severe proteinuria is a common reason for dose adjustment or discontinuation.
Countermeasures: It is recommended that patients regularly test urine routine and 24-hour urine protein before and during medication. If proteinuria occurs, the severity should be assessed according to CTCAE standards. If proteinuria is ≥ grade 2, dose reduction or medication suspension may be considered.
3. Fatigue and weakness
About half of the patients will feel obvious fatigue, which is related to the impact of lenvatinib on multiple signaling pathways. It may also be the result of long-term tumor consumption and the superposition of drug side effects.
Countermeasures: It is recommended to arrange work and rest time reasonably to ensure nutritional intake; if fatigue seriously affects daily life, short-term reduction or supportive treatment (such as supplementing vitamin B complex, iron, etc.) may be considered.
4. Gastrointestinal symptoms (diarrhea, nausea, loss of appetite)
These symptoms often appear in the early stages of medication and may affect the patient's nutrient absorption and treatment compliance. Some patients with severe diarrhea may even require hospitalization.

Countermeasures: Mild symptoms can be improved through dietary adjustments (eating smaller meals more often, avoiding greasy and spicy foods), and using antidiarrheal drugs (such as loperamide) and anti-nausea drugs (such as ondansetron) if necessary; in severe cases, medication can be suspended and intravenous rehydration and other symptomatic support can be provided.

2. Other adverse reactions that are relatively rare but require attention
1.Abnormal liver function
Although hepatotoxic reactions such as elevated liver enzymes and abnormal bilirubin are not as common as hypertension, they are particularly noteworthy in the treatment of liver cancer.
Countermeasures: Regularly detect liver function indicators such as ALT, AST, TBIL, etc.; when significant abnormalities occur, consider reducing the dose or discontinuing the drug, and supplement it with hepatoprotective treatment.
2. Thyroid dysfunction
Lenvatinib can cause hypothyroidism or hyperthyroidism, which is often manifested by fatigue, mood changes, weight changes, etc.
Countermeasures: Check thyroid function (TSH, FT3, FT4) before treatment, and monitor once a month during treatment. Levothyroxine can be supplemented for hypothyroidism, while hyperthyroidism should be treated according to the specific type.
3. Bleeding or thrombotic events
Lenvatinib may also cause increased capillary fragility by interfering with angiogenesis, leading to epistaxis, gastrointestinal bleeding, etc. Arterial or venous thrombosis has also been reported.
Countermeasures: High-risk patients need to carefully evaluate the risks of medication, such as those with hypertension, diabetes, and atherosclerosis; if there is bleeding during medication, they should seek medical treatment immediately. In severe cases, discontinuation of medication should be considered.
3. Medication recommendations and comprehensive management strategies
1. Individualized dose adjustment
The recommended starting dose of lenvatinib varies according to the indication and body weight. For example, the recommended starting dose in liver cancer is 12 mg/day (body weight ≥ 60 kg) or 8 mg/day (body weight < 60 kg). During treatment, the dose should be adjusted in time according to the adverse reactions to avoid blindly pursuing high doses that may lead to serious side effects.
2. Multidisciplinary collaborative management
TKI drugs have a wide range of side effects, involving multiple systems such as cardiovascular, digestive, endocrine, and skin systems. Therefore, they should be managed clinically through multidisciplinary collaboration (MDT). Oncology, cardiology, nutrition, etc. should jointly participate in patient follow-up and management.
3. Patient education and self-management
Strengthening patient education can significantly improve their ability to identify and deal with side effects. Encourage patients to record daily blood pressure, weight, diet and bowel movements, detect abnormalities as soon as possible and seek medical treatment; encourage family members to participate in medication supervision to improve compliance.
Lenvatinib, as a broad-spectrum anti-cancer targeted drug, plays an important role in the treatment of multiple advanced tumors, and its efficacy has been verified by multiple clinical studies. However, side effect management is a critical aspect of its treatment success. Through standardized monitoring, timely treatment, individualized dosage adjustment and strengthening patient education, most side effects can be controlled, which can not only extend the medication cycle, but also improve the patient's quality of life. In the future, with the accumulation of larger-scale real-world research data, the identification and management of lenvatinib's side effects will be more scientific and accurate, bringing hope to more cancer patients.
Reference: https://www.drugs.com