Lenvatinib Mesylate: Brands, Price & Uses in Bangladesh

Lenvatinib Mesylate is an oral multi-targeted tyrosine kinase inhibitor used in oncology. Its approved and guideline-supported indications, classified by evidence strength, are as follows.

FDA-approved / established indications

• Differentiated thyroid cancer (DTC): Treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer, as a single agent.
• Hepatocellular carcinoma (HCC): First-line treatment of unresectable hepatocellular carcinoma, as a single agent.
• Renal cell carcinoma (RCC) - requires combination therapy:
  • First-line treatment of advanced renal cell carcinoma, in combination with pembrolizumab.
  • Treatment of advanced renal cell carcinoma following one prior anti-angiogenic therapy, in combination with everolimus.
• Endometrial carcinoma - requires combination therapy: Treatment of advanced endometrial carcinoma that is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), in patients who have disease progression following prior systemic therapy and who are not candidates for curative surgery or radiation, in combination with pembrolizumab.

Lenvatinib Mesylate is not indicated as monotherapy for renal cell carcinoma or endometrial carcinoma; it must be used together with the specified partner agent for these indications. Use outside these established indications should only occur within a clinical trial or under specialist oncology guidance.

Dosing of Lenvatinib Mesylate depends on the indication being treated and, for some indications, body weight. Treatment should be initiated and supervised by a physician experienced in the use of anticancer therapies.

Capsules should be swallowed whole, at approximately the same time each day, with or without food. Dose interruption, reduction, or permanent discontinuation of Lenvatinib Mesylate may be required for management of adverse reactions such as hypertension, cardiac dysfunction, hepatotoxicity, renal impairment, or other significant toxicities (see Precautions and Warnings). Dose adjustment is recommended in severe hepatic or renal impairment. If a dose is missed and it cannot be taken within 12 hours, the missed dose should be skipped and the next dose taken at the regular time; a double dose should not be taken.

Side effects of Lenvatinib Mesylate are common, and many patients require dose modification. Reported reactions include the following.

Very common (may affect more than 1 in 10 people)

• Hypertension
• Diarrhea
• Fatigue and asthenia
• Decreased appetite and weight loss
• Nausea and vomiting
• Stomatitis and oral mucositis
• Palmar-plantar erythrodysesthesia (hand-foot syndrome)
• Proteinuria
• Hypothyroidism / increased thyroid-stimulating hormone
• Headache
• Dysphonia

Common but less frequent

• Abdominal pain, constipation
• Arthralgia/myalgia
• Rash, dry skin
• Dizziness
• Hemorrhagic events (e.g. epistaxis)

Serious reactions such as cardiac dysfunction, hepatotoxicity, renal failure, gastrointestinal perforation/fistula, and reversible posterior leukoencephalopathy syndrome can also occur; see Precautions and Warnings.