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Lenvatinib is FDA-approved for the treatment of radioactive iodine-refractory differentiated thyroid cancer (DTC), unresectable or advanced hepatocellular carcinoma (HCC), advanced renal cell carcinoma (RCC), and advanced endometrial carcinoma. The multiple receptor tyrosine kinase inhibitor demonstrates potent antiangiogenic properties. The inhibition of the VEGF receptors prevents tumor angiogenesis, and the inhibition of FGFR, RET, PDGFRa, and KIT prevents further proliferation of malignant cells. The prescribing team should include primary care clinicians, oncologists, nurses, and pharmacists, crucial for early diagnosis, monitoring potential adverse effects, and optimizing dosage adjustments based on renal function, liver enzymes, body weight, and cardiac health. Routine monitoring for adverse effects like hypertension, cardiac impairment, QT interval prolongation, thyroid function changes, and reproductive considerations is necessary, along with patient education for better treatment outcomes and increased quality of life. This activity highlights the mechanism of action, adverse event profile, and other key factors pertinent to interprofessional team members in managing patients with gastrointestinal or uterine cancers. Participating clinicians are informed to make decisions and optimize dosage regimens while minimizing adverse reactions. Objectives: Identify the mechanism of action of lenvatinib in comparison to other tyrosine kinase inhibitors. Assess the adverse drug reactions of lenvatinib depending on past medical history and stage of malignancy. Evaluate the appropriate monitoring strategies for patients undergoing therapy with lenvatinib. Implement collaboration among interprofessional team members to improve treatment efficacy for patients with late-stage cancers who are prescribed lenvatinib. Access free multiple choice questions on this topic.

Fetal harm was observed in animal trials during the administration of lenvatinib at a dosage below the recommended range. No reproductive studies have been conducted to analyze the toxicity in humans. Pregnant women should be counseled and advised of possible toxicity to the fetus. Lenvatinib may be present during lactation, and halting breastfeeding is recommended for 1 week following the last dosage.[16]

Lenvatinib is an FDA-approved multiple receptor tyrosine kinase inhibitor indicated for treating radioactive iodine-refractory DTC, unresectable HCC, and advanced RCC. Patients with these malignancies require critical care from an interprofessional team. Early diagnosis and management can decrease life-long complications, improve life quality, and decrease mortality. The interprofessional team includes a primary care clinician, an oncologist, a nurse, and a pharmacist. Primary care clinicians and specialists should thoroughly educate their patients about the disease course and management and the potential adverse effects of therapy. The primary care clinician, oncologist, and pharmacy oncology specialist team should routinely monitor renal function and liver enzymes, as lenvatinib is metabolized and cleared in the liver and kidneys, respectively, and dosage modifications may be necessary. When treating HCC, the body weight should be routinely monitored, as the therapy dosage is determined based on actual body weight. This is where a specialized oncology pharmacist can provide valuable input. Lenvatinib has a wide array of adverse effects, and routine follow-ups are vital to prevent complications and long-term harm. Anti-emetics should be considered with the use of lenvatinib due to nausea and vomiting. An EKG is recommended, and the QT interval should be reviewed before selecting which medication to use, as certain anti-emetics can prolong the QT interval. Cardiac impairment and QT-interval prolongation are also adverse effects. Hypertension is the most reported side effect, and routine blood pressure checks are advised. Early detection can be made by 24-hour blood pressure monitoring. Patients with an underlying history of hypertension should have their blood pressure controlled and maintained in a stable range before initiating therapy. Patients with uncontrolled increases in their blood pressure while receiving optimal treatment for blood pressure should discontinue lenvatinib. In the occurrence of cardiac impairment such as heart failure, cardiomyopathy, or ventricular dysfunction, a cardiologist should be consulted. Thyroid function monitoring should also be routine, as lenvatinib use can result in thyroid gland hypofunction.

Hypertension is the most reported side effect, and routine blood pressure checks are advised. Early detection can be made by 24-hour blood pressure monitoring. Patients with an underlying history of hypertension should have their blood pressure controlled and maintained in a stable range before initiating therapy. Patients with uncontrolled increases in their blood pressure while receiving optimal treatment for blood pressure should discontinue lenvatinib. In the occurrence of cardiac impairment such as heart failure, cardiomyopathy, or ventricular dysfunction, a cardiologist should be consulted. Thyroid function monitoring should also be routine, as lenvatinib use can result in thyroid gland hypofunction. During reproductive animal investigations, lenvatinib has been shown to harm the fetus if present in breast milk. Pregnant women should be advised about the likely effects on the fetus and should discontinue breastfeeding for one week following the last dosage of lenvatinib. Interprofessional interaction between healthcare professionals and patients is essential to strengthening rapport and forming a therapeutic alliance. Compliance with therapy is vital in the management of malignancies. This minimizes treatment delays and enhances outcomes and the quality of life. A retrospective study evaluated the efficacy of lenvatinib in patients with unresectable radioactive iodine therapy refractory differentiated thyroid cancer across multiple institutions. Fifty-one patients were analyzed, and overall survival and progression-free survival were calculated. Planned drug holidays were implemented to mitigate adverse events. The study found that patients with planned drug holidays experienced significantly improved overall survival, progression-free survival, and time to treatment failure compared to those without planned drug holidays. However, various administration schedules were observed during planned drug holidays. The study underscores the importance of an individualized, patient-centered approach to administration schedules to optimize treatment outcomes in patients with DTC.

A retrospective study evaluated the efficacy of lenvatinib in patients with unresectable radioactive iodine therapy refractory differentiated thyroid cancer across multiple institutions. Fifty-one patients were analyzed, and overall survival and progression-free survival were calculated. Planned drug holidays were implemented to mitigate adverse events. The study found that patients with planned drug holidays experienced significantly improved overall survival, progression-free survival, and time to treatment failure compared to those without planned drug holidays. However, various administration schedules were observed during planned drug holidays. The study underscores the importance of an individualized, patient-centered approach to administration schedules to optimize treatment outcomes in patients with DTC. A retrospective study investigated the impact of a collaborative program between medical oncologists and pharmacists on managing patients with thyroid cancer undergoing lenvatinib therapy. Pharmacists were pivotal in monitoring patients for adverse reactions, conducting interventions, and consulting with oncologists. The study aimed to prevent unnecessary treatment interruptions or dose reductions through this collaboration. Results indicated that pharmacist interventions significantly reduced treatment interruptions and dose adjustments, improving patient outcomes. This underscores the importance of multidisciplinary teamwork in optimizing medication therapy and enhancing patient care in oncology settings. By implementing an interprofessional team approach that involves clinicians, oncologists, nursing staff, pharmacists, and the patient and their family, the likelihood of successful therapeutic outcomes increases, with a reduced potential for adverse events.[20][28][29]