Managing Lenvatinib’s Adverse Effects in RAI-Refractory DTC


Lori J. Wirth, MD, discusses safety data from the phase 3 SELECT trial which evaluated lenvatinib in radioactive iodine-refractory differentiated thyroid cancer.

Lori J. Wirth, MD, associate professor of medicine at Harvard Medical School and medical director of the Center for Head and Neck Cancers at Massachusetts General Hospital, discusses the safety data from the phase 3 SELECT trial (NCT01321554) which evaluated lenvatinib (Lenvima) compared with placebo for the treatment of patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC).

Lenvatinib is a multikinase inhibitor. The agent was granted approval from the FDA in 2015 based on safety and efficacy results from the SELECT trial.

According to Wirth, the adverse events (AEs) observed with lenvatinib in this phase 3 study were similar to those seen previously with other VEGFR multikinase inhibitors. Common AEs include hypertension, diarrhea, decreased appetite, weight loss, rash, and more. Less common AEs seen with the agent consist of hand-foot syndrome, liver problems, and an irregular heartbeat. In rare cases, lenvatinib can also increase bleeding or blood clotting.

In an interview with Targeted OncologyTM, Wirth also highlights how one can manage and monitor the AEs that are often observed with the agent.


0:09 | Lenvatinib is a multikinase inhibitor, and it does inhibit VEGFR1, 2, and 3, as well as several other kinases, and it does have [adverse] effects that are very similar to other VEGFR multikinase inhibitors. So, the most common [adverse] effects that we encountered in SELECT were hypertension, diarrhea, fatigue, maybe a little bit of nausea, [and] anorexia.

0:38 | We did see some palmar plantar erythrodysesthesia, [that is] the hand-foot syndrome, and then other less common toxicities included transaminitis, there was a relatively low rate of prolonged QT interval, but important to know about because it needs to be monitored, of course. And then there are also very uncommon but potentially serious [adverse] effects that include increasing bleeding or blood clotting disorders.

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