Patient description: A 54-year-old obese woman admitted to the emergency department with abdominal pain that started 4 days ago with nausea and vomiting. The epigastric pain radiates to the right upper quadrant, getting worse after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and 2 NVDs. She has 2 children, and she is menopausal. She does not smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. She is an obese woman with no acute distress. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones, biliary sludge and CBD stones. The smallest stone is 14mm.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Advanced Solid Tumors Triple Negative Breast Cancer Ovarian Cancer Gastric Cancer Colorectal Cancer Glioblastoma Biliary Tract Cancers Pancreatic Cancer Has a histologically or cytologically-documented, advanced (metastatic and/or unresectable) solid tumor that is incurable and for which prior standard systemic therapy has failed in one of the following cohorts: TNBC, Ovarian Cancer, Gastric Cancer, Colorectal Cancer, GBM, BTC (intrahepatic, extrahepatic cholangiocarcinoma and gall bladder cancer; excludes Ampulla of Vater), Pancreatic Cancer Must have progressed on or since the last treatment Has measurable disease per 1.1 (RANO for the GBM cohort) as assessed by the local site investigator/radiology and confirmed by BICR Has provided a PD-L1 evaluable archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated Male participants agree to use approved contraception during the treatment period for at least 7 days after the last dose of lenvatinib, or refrain from heterosexual intercourse during this period Female participants are not pregnant or breastfeeding, and are not a woman of childbearing potential (WOCBP), OR are a WOCBP that agrees to use contraception during the treatment period (or 14 days prior to the initiation of study treatment for oral contraception) and for at least 120 days post pembrolizumab, or 30 days post lenvatinib, whichever occurs last Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1 within 3 days of study treatment initiation Has adequate organ function For Triple Negative Breast Cancer Participants Has received one or 2 prior lines of therapy Has Lactate Dehydrogenase (LDH) <2.0 x Upper Limit of Normal (ULN)  Has presence of gastrointestinal condition including malabsorption that might affect the absorption of lenvatinib Has present or progressive accumulation of pleural, ascitic, or pericardial fluid requiring drainage or diuretic drugs within 2 weeks prior to enrollment (applies to all cohorts except the ovarian cancer cohort) Has radiographic evidence of major blood vessel invasion/infiltration. Participants with portal vein invasion (Vp4), inferior vena cava, or cardiac involvement based on imaging in the BTC cohort are excluded Has clinical significant hemoptysis or tumor bleeding within 2 weeks prior to the first dose of study treatment Has significant cardiovascular impairment within 12 months of the first dose of study treatment: such as history of congestive heart failure greater than New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction or cerebrovascular accident (CVA), or cardiac arrhythmia associated with hemodynamic instability Has a history of arterial thromboembolism within 12 months of start of study treatment Has a known additional malignancy that is progressing or has required active treatment within the past 3 years Serious nonhealing wound, ulcer or bone fracture Has had major surgery within 3 weeks prior to first dose of study interventions Has biologic response modifiers (e.g. granulocyte colony-stimulating factor) within 4 weeks before study entry