How to determine the dosage of lenvatinib/lenvatinib? What to do after missing a dose

Lenvatinib/Lenvatinib (Lenvatinib) is an oral multi-target tyrosine kinase inhibitor, and individualized adjustment of its dosage is crucial in treatment. Recommended dosages vary depending on the indications. For patients with differentiated thyroid cancer (DTC), the standard dose is 24 mg once a day; for patients with hepatocellular carcinoma (HCC), the dose is based on body weight, with 12 mg once a day for patients weighing ≥60 kg and 8 mg once a day for patients <60 kg. In combination treatment scenarios, such as when combined with pembrolizumab for the treatment of endometrial cancer, the recommended starting dose of lenvatinib is 20 mg once a day; if combined with everolimus for the treatment of renal cell carcinoma, the starting dose is 18 mg once a day, and everolimus is 5 mg once a day. Whether used as a single agent or in combination, the dosage may be adjusted based on the patient's tolerance, liver and kidney function status, and the occurrence of adverse reactions.

During actual use, missed doses of lenvatinib are a common clinical problem. If the patient discovers that he has missed a dose, he should judge whether to take it again based on the time between the missed dose and the next dose. Generally speaking, if it is more than 12 hours before the next dose, you can take the dose in time; if it is less than 12 hours, it is recommended to skip the missed dose and do not try to add or double the dose to avoid the risk of overdose. This principle is based on the pharmacokinetic properties of lenvatinib, which has a long peak plasma concentration and half-life. Occasional missed doses will not immediately affect the efficacy, but continuous missed doses may weaken treatment control.

In addition, in patients with hepatic insufficiency or renal impairment, the metabolism and clearance of lenvatinib may be altered, and physicians will adjust the dose according to the level of hepatic and renal function. For example, patients with moderate liver function impairment are usually recommended to reduce the dose, while patients with severe liver impairment need to use it more cautiously and consider suspending it if necessary.

Reference materials:https://www.lenvima.com/