Lenvatinib (Lenvima)

==General information==
Class/mechanism: Tyrosine kinase inhibitor of multiple receptor tyrosine kinases (RTKs), including: vascular endothelial growth factor (VEGF) receptors VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4); fibroblast growth factor (FGF) receptors FGFR1, FGFR2, FGFR3, and FGFR4; platelet derived growth factor receptor alpha (PDGFRα), KIT, and RET. Inhibition of these receptor tyrosine kinases interferes with cancer cells' proliferation and pathogenic angiogenesis.Lenvatinib (Lenvima) package insertLenvatinib (Lenvima) package insert (locally hosted backup)Lenvima manufacturer's website
Route: PO
Extravasation: n/a
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, UpToDate Lexidrug, or the package insert.
==Diseases for which it is established==
*Endometrial cancer
*Hepatocellular carcinoma
*Renal cell carcinoma
*Differentiated thyroid cancer
==Diseases for which it is used==
*Cholangiocarcinoma
==Patient drug information==
*Lenvatinib (Lenvima) package insert
*Lenvatinib (Lenvima) patient drug information (Chemocare)Lenvatinib (Lenvima) patient drug information (Chemocare)
*Lenvatinib (Lenvima) patient drug information (UpToDate)Lenvatinib (Lenvima) patient drug information (UpToDate)
==History of changes in FDA indication==
===Differentiated thyroid cancer===
*2015-02-13: Approved for the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer. (Initial approval; based on SELECT)
===Endometrial cancer===
*2019-09-17: Accelerated approval in combination with Pembrolizumab (Keytruda) for the treatment of patients with advanced endometrial carcinoma that is not microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR) and who have disease progression following prior systemic therapy but are not candidates for curative surgery or radiation. (Based on KEYNOTE-146)
**2021-07-21: Converted to regular approval in combination with Pembrolizumab (Keytruda) for the treatment of patients with advanced endometrial carcinoma that is not microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR) and who have disease progression following prior systemic therapy but are not candidates for curative surgery or radiation. (Based on KEYNOTE-775)
===Hepatocellular carcinoma===
*2018-08-16: Approved for first-line treatment of patients with unresectable hepatocellular carcinoma (HCC). (Based on REFLECT)
===Renal cell carcinoma===
*2016-05-13: Approved in combination with everolimus, for the treatment of advanced renal cell carcinoma following one prior anti-angiogenic therapy. (Based on E7080-G000-205)
*2021-08-10: Approved in combination with Pembrolizumab (Keytruda) for first-line treatment of adult patients with advanced renal cell carcinoma (RCC). (Based on CLEAR)
==History of changes in EMA indication==
===Differentiated thyroid cancer===
*2015-05-28: Initial authorization as Lenvima. Lenvima is indicated as monotherapy for the treatment of adult patients with progressive, locally advanced or metastatic, differentiated (papillary/follicular/Hürthle cell) thyroid carcinoma (DTC), refractory to radioactive iodine (RAI).
===Endometrial cancer===
*2021-11-26: Extension of indication to include lenvatinib in combination with pembrolizumab for the treatment of adult patients with advanced endometrial carcinoma (EC) who have disease progression following prior systemic therapy in any setting and are not candidates for curative surgery or radiation.
===Hepatocellular carcinoma===
*2018-08-20: Lenvima is indicated as monotherapy for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma (HCC) who have received no prior systemic therapy.
===Renal cell carcinoma===
*2016-08-25: Initial authorization as Kisplyx. Kisplyx is indicated in combination with everolimus for the treatment of adult patients with advanced renal cell carcinoma (RCC) following one prior vascular endothelial growth factor (VEGF)-targeted therapy. (Based on E7080-G000-205)
*2021-11-26: Extension of indication to include Kisplyx in combination with pembrolizumab first line treatment of adults with advanced renal cell carcinoma (RCC).
==History of changes in Health Canada indication==
*2019-09-20: Notice of compliance with conditions in combination with pembrolizumab, for the treatment of adult patients with advanced endometrial carcinoma that is not microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR), who have disease progression following prior platinum-based systemic therapy, and are not candidates for curative surgery or radiation.
==History of changes in PMDA indication==
===Endometrial cancer===
*2021-12-24: New indication and a new dosage for the treatment of unresectable advanced or recurrent endometrial carcinoma that has progressed after cancer chemotherapy.
===Hepatocellular carcinoma===
*2018-03-23: New additional indication and a new dosage indicated for the treatment of unresectable hepatic cell carcinoma.
===Renal cell carcinoma===
*2022-02-25: New indication and a new dosage for the treatment of unresectable or metastatic renal cell carcinoma.
===Thymic carcinoma===
*2021-03-21: New indication for the treatment of unresectable thymic carcinoma.
===Thyroid cancer===
*2015-03-26: Initial approval for the treatment of unresectable thyroid cancer.
==Also known as==
*Code name: E-7080
*Brand name: Kisplyx, Lenvima
==References==
Category:Drugs
Category:Oral medications
Category:VEGFR inhibitors
Category:FGFR inhibitors
Category:PDGFR inhibitors
Category:KIT inhibitors
Category:RET inhibitors
Category:Cholangiocarcinoma medications
Category:Endometrial cancer medications
Category:Hepatocellular carcinoma medications
Category:Renal cell carcinoma medications
Category:Thyroid cancer, differentiated medications
Category:FDA approved in 2015
Category:EMA approved in 2015
Category:PMDA approved in 2015