Lenvatinib (Lenvima®, Kisplyx®) is a targeted therapy drug. It is used to treat some types of kidney, thyroid and liver cancers.
Lenvatinib is used to treat:
- papillary or follicular thyroid cancer that is no longer being controlled by radioactive iodine treatment
- a type of kidney cancer called renal cell carcinoma that has spread outside the kidney
- some primary advanced liver cancers.
It may also be used to treat other cancers, such as womb cancer, in a clinical trial.
It is best to read this information with our general information about the type of cancer you have.
Lenvatinib belongs to a group of targeted therapy drugs called angiogenesis inhibitors. These stop the cancer developing new blood vessels. It is also a cancer growth inhibitor which blocks signals in the cancer cells that make them grow.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Lenvatinib is given as capsules, so you can take it at home. You may have lenvatinib on its own or in combination with other targeted drugs.
During treatment, you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You will have regular blood tests throughout your treatment. These allow your doctor to check the levels of different blood cells in your body (your blood count). They also show how your liver and kidneys are working.
Lenvatinib can reduce the levels of substances called electrolytes in your blood, such as potassium, magnesium and calcium. You will have regular blood samples taken to check for this.
Taking lenvatinib capsules
You take lenvatinib capsules once a day, with or without food.
Swallow them whole with a glass of water. Do not chew, open or crush them. Take them at the same time every day. If you struggle to swallow the capsules, speak to your doctor or pharmacist.
If you forget to take your lenvatinib capsules and it is more than 12 hours until the next dose, take them as soon as you remember. If it is less than 12 hours until the next dose, do not take the missed dose. Take your usual dose at the usual time the next day. You should never take a double dose.
Do not ask someone to open the capsules for you. This is because they may be exposed to the drug, which may be harmful to them. If someone else needs to open them for you, they should wear gloves.
Other things to remember about your capsules:
- Wash your hands after taking your capsules.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused capsules to the pharmacist.
Your course of treatment
Your nurse, pharmacist or doctor will discuss your treatment plan with you. Usually, you continue taking lenvatinib for as long as it is working for you and side effects can be managed. Do not stop taking it without your doctor’s advice.
If you are having difficult side effects, your doctor may suggest stopping the treatment for a short time or they may lower the dose.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Your doctor can give you anti-sickness drugs if you feel sick. These drugs help prevent or control sickness during treatment. Take them exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Lenvatinib can also cause indigestion. Tell your doctor or nurse if this happens.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco and foods that irritate your mouth and throat.
Lenvatinib can also cause a dry mouth. Taking regular sips of water or sucking ice cubes or sugar-free lollies can help.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Loss of appetite
This treatment can affect your appetite. Don't worry if you do not eat much for a day or 2. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.
Changes in your blood pressure
Lenvatinib can increase your blood pressure. Some people may need to take tablets to control their blood pressure. Lenvatinib can also cause blood pressure to become lower, but this is less common.
Your nurse will check your blood pressure regularly.
This treatment may cause headaches. If you have headaches, tell your doctor. They may give you painkillers to help.
This treatment may affect your skin. It can cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Some people may get areas of skin thickening.
Always tell your doctor or nurse about any skin changes or if skin changes get worse. They can give you advice and may prescribe creams or medicines to help.
Sore and red palms of hands and soles of feet
You may get sore and red palms of hands and soles of feet. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.
Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:
- keep your hands and feet cool
- moisturise your hands and feet regularly
- avoid tight-fitting socks, shoes and gloves.
Muscle, joint or back pain
You may get pain in your muscles, joints, or back. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better.
Build-up of fluid
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
Lenvatinib can sometimes cause other types of bleeding which can be serious. Contact the hospital straight away on the number you have been given if, for example, you:
- have black or bloodstained stools
- vomit or cough up blood
- have vomit that looks like coffee grounds.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
Effects on the thyroid gland
Lenvatinib can sometimes make the thyroid gland less active. Your doctor will check how your thyroid is working with regular blood tests. Possible symptoms of thyroid changes include:
- tiredness and difficulty concentrating
- feeling depressed
- weight gain
- feeling cold
- dry skin and dry hair.
If you notice any symptoms, tell your doctor. Thyroid changes can be treated with medication. They go back to normal after the treatment is finished.
If you have had your thyroid gland removed, the dose of your thyroid hormone replacement tablets may need to be changed.
Changes in the way the liver and kidneys work
This treatment can affect how your liver and kidneys work. You will have blood tests before and during treatment to check how your liver and kidneys are working.
Your urine will also be tested for protein while you are having this treatment.
You may notice your hair becomes thinner. We have more information about coping with hair loss.
Changes to your voice
You may notice changes to your voice. Tell your doctor or nurse if this happens.
Tummy (abdominal) pain
If you get a sudden, sharp pain in your tummy (abdomen) contact the hospital straight away. Rarely, lenvatinib may cause a tear (perforation) in the tummy or bowel. Other symptoms include vomiting blood or passing blood in your stools.
Lenvatinib may also cause swelling of the gall bladder or of the pancreas. This can also cause pain in the tummy. Contact the hospital if this happens.
Effects on the heart
This treatment can affect how the heart works. You will have tests to see how well your heart is working. These are done before, during and after treatment. If tests show signs of heart changes or you develop symptoms of heart problems, these can be treated with tablets.
Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Blood clot risk
Cancer increases the chances of a blood clot. Lenvatinib can also increase the risk. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Increased risk of stroke
Lenvatinib may increase the risk of a mini stroke or stroke. But this is not common. Contact a doctor straight away if you or other people notice you have any of these symptoms:
- feeling confused
- difficulty speaking
- drooping of the face
- numbness or weakness on one side of your body.
Effects on the nervous system
Rarely, lenvatinib can affect the nervous system. If you have headaches, changes in your eyesight, confusion or seizures contact a doctor straight away.
Rarely, lenvatinib can cause a fistula. A fistula is an abnormal opening that connects two or more parts of the body. This may be in an area of the body where you have had surgery or radiotherapy.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. It is not known if lenvatinib makes the contraceptive pill less effective so you or your partner should also use barrier contraception (a condom).
Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
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