Lenvatinib is a targeted therapy drug used to treat some types of kidney and thyroid cancers. It may also be used to treat primary liver cancer.
Lenvatinib (Lenvima®, Kisplyx®) is a type of targeted therapy drug called a tyrosine kinase inhibitor. It works by blocking (inhibiting) signals in the cancer cells that make them grow. Blocking the signals causes the cells to die.
Lenvatinib can also stop cancer cells developing new blood vessels. This reduces their supply of oxygen and nutrients, so the tumour shrinks or stops growing.
Lenvatinib is used to treat people with:
- differentiated thyroid cancer (DTC) that is no longer being controlled by radioactive iodine treatment
- kidney cancer (renal cell carcinoma) that has spread outside the kidney.
It may also be used to treat primary liver cancer.
For kidney cancer, lenvatinib is usually given with everolimus (Afinitor®).
Lenvatinib may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial. If a drug is not routinely available on the NHS, there may be other ways you can get access to it. Your cancer doctor can give you advice.
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.
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.
Always take your capsules exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.
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 capsules in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- Return any unused capsules to the pharmacist if your treatment is stopped.
- If you are sick just after taking the capsules, tell your doctor. You may need to take another dose. Do not take another dose without telling your doctor, nurse or pharmacist first.
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 haven’t 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 prescribe anti-sickness drugs (anti-emetics) to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.
If you are sick just after taking the capsules, tell your doctor. You may need to take another dose. Do not take another dose without telling your doctor, nurse or pharmacist first.
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.
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.
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
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. You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure. Lenvatinib can also cause a person’s blood pressure to become lower, but this is less common.
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. Any changes to your skin are usually temporary and improve when treatment finishes.
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. It gets better when treatment ends. 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 to 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.
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if this happens. The swelling gets better after your treatment ends.
Bruising and bleeding
Lenvatinib can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. This can sometimes cause bleeding problems, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Or you may find you bruise more easily. Tell your doctor if you are taking any medicines that may affect bleeding.
Contact your doctor straight away if you have any unusual bleeding, including vomiting or coughing up blood, unexpected vaginal bleeding or blood in your poo (stool).
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:
- feeling depressed
- difficulty concentrating
- weight gain
- feeling cold
- dry skin
- 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 kidneys and liver work
This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before starting the treatment to check how well your kidneys and liver are working. Your urine will also be tested for protein while you are having this treatment.
You may notice your hair becomes thinner during treatment. This is usually temporary and hair grows back when you stop taking the capsules. We have information on coping with hair loss.
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 type 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.
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.
Increased risk of blood clots
Cancer increases the chances of a blood clot (thrombosis) and this treatment 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.
This treatment may increase the risk of having a stroke. Contact a doctor immediately if you have numbness or weakness on one side of your body, changes to your eyesight or difficulty speaking.
Effects on the nervous system
Rarely, lenvatinib can affect the nervous system. You may feel confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice this.
Very 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, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.
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 this treatment.