Lenvatinib (Lenvima®, Kisplyx®)
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:
- differentiated thyroid cancer that is no longer being controlled by radioactive iodine treatment
- advanced kidney cancer (renal cell carcinoma)
- liver cancer (hepatocellular cancer) that is advanced or that cannot be removed with surgery.
Levatinib is a type of targeted therapy drug called an angiogenesis inhibitor. It is also a cancer growth inhibitor drug.
It is best to read this information with our general information about the type of cancer you have.
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. Lenvatinib can be given on its own or in combination with other cancer drugs. If you have kidney cancer you may have lenvatinib with everolimus. For thyroid cancer you have it on its own or with sorafenib.
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 samples taken throughout your treatment. These allow your doctor to check the levels of different blood cells (blood count) in your body and how your liver and kidneys are working.
Your doctor or nurse will tell you how often you will have them checked.
Your course of lenvatinib
The nurse or pharmacist will give you the capsules to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given capsules of different strengths.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they have been explained to you.
Taking lenvatinib capsules
You take lenvatinib capsules once a day. You should take them at the same time every day, with or without food. Swallow the capsules whole with a glass of water. They should not be chewed, opened or crushed. If you struggle to swallow the capsules, speak to your doctor or pharmacist.
Always take your capsules exactly as your nurse or pharmacist explained.
If you forget to take your lenvatinib capsules, and it is more than 12 hours until the next dose, take it 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.
There are some important things to remember when 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.
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.
Sometimes, if you are having bad side effects, your doctor may suggest stopping the treatment for a short time. Or they may lower the dose of the capsules. This is to help you to continue your treatment without these side effects.
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.
If you feel sick your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs 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 and eat small amounts often. If you continue to feel sick, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
This treatment may cause diarrhoea. This can usually be easily controlled by taking anti-diarrhoea drugs. You should tell your doctor straight away if you have diarrhoea, so they can prescribe these for you. It is important to drink plenty of fluids if you have diarrhoea. Try to drink around 2 litres (3½ pints) a day. If you are already taking anti-diarrhoea drugs and your symptoms do not get better within a day, tell your doctor.
This treatment can cause constipation. 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.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth 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.
You may find that food tastes different while you are taking lenvatinib. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Loss of appetite
You may lose your appetite during treatment and may lose weight. Try to eat small meals regularly. If your appetite does not improve after a few days, tell your doctor or nurse. They can arrange for you to see a dietitian, who can give you advice. You may be given food supplements or meal replacement drinks to try. Your doctor can prescribe some of these. You can also buy them from chemists.
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 this happens, tell your doctor or nurse. They can give you painkillers.
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
Always tell your doctor or nurse about any skin changes or if they get worse. They can give you advice and may prescribe creams or medicines to help.
Sore and red hands and feet
Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and avoid tight-fitting socks, shoes and gloves. Tell your nurse about any changes in your hands or feet.
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 contact number you have been given if you have abnormal bleeding, for example:
- passing black or bloodstained stools
- vomiting or coughing 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. If this happens, it can be treated with medication and goes 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 develop sudden, sharp pain in your tummy (abdomen) contact the hospital straightaway. 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 the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the dose of treatment you are having.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
Increased risk of blood clots
Cancer increases the chances of a blood clot (thrombosis) and lenvatinib can add to this. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away. A blood clot is serious but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Increased risk of stroke
Lenvatinib may increase the risk of a mini stroke or stroke but this is not common. Contact a doctor straightaway if you or someone else notices:
- you are confused
- you have 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, 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.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live 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. Your doctor, nurse or pharmacist can tell you more about this.
It is not known if lenvatinib affects how the oral contraceptive pill works. Because of this it is important to use a barrier method of contraception as well.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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.