|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 177-178
Lenvatinib: With more power comes more toxicity
Onco Cancer Care, Hyderabad, Telangana, India
|Date of Submission||12-Jan-2022|
|Date of Decision||26-Jan-2022|
|Date of Acceptance||27-Jan-2022|
|Date of Web Publication||31-Mar-2022|
Onco Cancer Care, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S. Lenvatinib: With more power comes more toxicity. Cancer Res Stat Treat 2022;5:177-8
Lenvatinib is an oral multityrosine kinase inhibitor (TKI) that has a wide spectrum of approved indications including thyroid, endometrial, hepatocellular, and renal carcinomas. In the previous issue of CRST, the narrative review of this drug by Goel and Singla must be commended for its comprehensive nature.
Lenvatinib, alone or in combination with immune checkpoint inhibitors (iCPis), has become the standard of care in the first-line systemic therapy of many solid tumors., The CLEAR trial in advanced renal cell carcinoma by Motzer et al. reported a median progression-free survival of 23.9 months and an objective response rate (ORR) of 71%. With the caveat of cross-trial comparisons, these results are superior to those achieved with other first line iCPi plus oral TKI-containing regimens., However, these results came at the cost of significant side effects. A starting dose of 20 mg was chosen for lenvatinib, and 68.8% patients needed a dose reduction, whereas 25% patients discontinued the drug due to unacceptable side effects. The most common significant side effects include diarrhea, palmar − plantar erythrodysesthesia syndrome, hypertension, and weight loss.
A lower starting dose of lenvatinib of 14 mg seems to be more prudent, which can be escalated if the patient tolerates this dose well. In a phase II trial, Pal et al. had reported that there was no significant difference in the ORR between 14 mg and 18 mg doses of lenvatinib, in combination with everolimus for renal cell carcinoma. Indeed, a body weight-based dosing strategy of lenvatinib (<60 kg–8 mg, ≥60 kg–12 mg) based upon pharmacokinetic modeling in hepatocellular carcinomas as done in the REFLECT trial was much better tolerated, with only 37% patients needing a dose reduction and 9% needing a drug withdrawal.
The significance of maintaining the patient's quality-of-life during treatment cannot be over-emphasized. Clinical trial data cannot be directly extrapolated to the real-world setting, especially in a low- and middle-income country like India, where treatment toxicity, both physical and financial, are major hurdles in achieving desirable outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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