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Lenvatinib Dosage

Medically reviewed by Drugs.com. Last updated on Oct 3, 2019.

Applies to the following strengths: 4 mg; 8 mg daily-dose; 10 mg; 12 mg daily-dose; 14 mg daily-dose; 18 mg daily-dose; 20 mg daily-dose; 24 mg daily-dose

Usual Adult Dose for Thyroid Cancer

24 mg orally once a day
Duration of therapy: Until disease progression or unacceptable toxicity

Use: For locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer (DTC)

Usual Adult Dose for Renal Cell Carcinoma

18 mg in combination with 5 mg everolimus orally once a day
Duration of therapy: Until disease progression or unacceptable toxicity

Comments: Refer to everolimus prescribing information for recommended everolimus dosing information.

Use: In combination with everolimus for the treatment of advanced renal cell carcinoma (RCC) following one prior anti-angiogenic therapy

Usual Adult Dose for Hepatocellular Carcinoma

-Weight less than 60 kg: 8 mg orally once a day
-Weight 60 kg or greater: 12 mg orally once a day

Duration of therapy: Until disease progression or unacceptable toxicity

Use: For the first-line treatment of unresectable hepatocellular carcinoma (HCC)

Usual Adult Dose for Endometrial Carcinoma

20 mg orally once daily in combination with pembrolizumab 200 mg IV over 30 minutes every 3 weeks disease progression or unacceptable toxicity

Use: In combination with pembrolizumab for the treatment of patients with advanced endometrial carcinoma that is not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) who have disease progression following prior systemic therapy and are not candidates for curative surgery or radiation

Renal Dose Adjustments

-Mild (CrCl 60 to 89 mL/min) to moderate (CrCl 30 to 59 mL/min) renal impairment: No adjustment recommended.
-Severe renal impairment (CrCl less than 30 mL/min):
1) For differentiated thyroid cancer (DTC), reduce the dose to 14 mg orally once a day.
2) For renal cell carcinoma (RCC), reduce the dose to 10 mg taken orally once a day.
3) For endometrial carcinoma, reduce the dose to 10 mg orally once a day.
-End stage renal disease: Data not available

Liver Dose Adjustments

-Mild (Child-Pugh A) to moderate (Child-Pugh B) hepatic impairment: No adjustment recommended.
-Severe hepatic impairment (Child-Pugh C):
1) For differentiated thyroid cancer (DTC), reduce the dose to 14 mg orally once a day.
2) For renal cell carcinoma (RCC), reduce the dose to 10 mg orally once a day.
3) For endometrial carcinoma, reduce the dose to 10 mg orally once a day.

Dose Adjustments

When administering this drug in combination with everolimus, reduce the dose of this drug first and then the everolimus dose for adverse reactions of both drugs. Refer to the everolimus prescribing information for additional dose modification information.

When administering this drug in combination with pembrolizumab for the treatment of endometrial carcinoma, interrupt one or both drugs or dose reduce this drug as appropriate. No dose reductions are recommended for pembrolizumab. Withhold or discontinue pembrolizumab in accordance with the pembrolizumab prescribing information.

DOSE REDUCTION BASED ON THE PREVIOUS DOSE LEVEL:
INITIAL DOSE LEVEL of 24 mg orally once a day:
-First occurrence: Reduce dose to 20 mg orally once a day.
-Second occurrence: Reduce dose to 14 mg orally once a day.
-Third occurrence: Reduce dose to 10 mg orally once a day.
INITIAL DOSE LEVEL of 18 mg orally once a day:
-First occurrence: Reduce dose to 14 mg orally once a day.
-Second occurrence: Reduce dose to 10 mg orally once a day.
-Third occurrence: Reduce dose to 8 mg orally once a day.
INITIAL DOSE LEVEL of 12 mg orally once a day:
-First occurrence: Reduce dose to 8 mg orally once a day.
-Second occurrence: Reduce dose to 4 mg orally once a day.
-Third occurrence: Reduce dose to 4 mg orally every other day.
INITIAL DOSE LEVEL of 8 mg orally once a day:
-First occurrence: Reduce dose to 4 mg orally once a day.
-Second occurrence: Reduce dose to 4 mg orally every other day.
-Third occurrence: Discontinue therapy.

Recommended Dose Modifications for Adverse Reactions:
HYPERTENSION:
-Grade 3: Withhold for Grade 3 that persists despite antihypertensive therapy; resume at reduced dose when hypertension is controlled at Grade 2 or less.
-Grade 4: Permanently discontinue therapy.
CARDIAC DYSFUNCTION:
-Grade 3: Withhold until improves to Grade 0 to 1 or baseline; resume at reduced dose or discontinue depending on the severity and persistence of adverse reaction.
-Grade 4: Permanently discontinue therapy.
ARTERIAL THROMBOEMBOLIC EVENT:
-Any Grade: Permanently discontinue therapy.
HEPATOTOXICITY:
-Grade 3 or 4: Withhold until improves to Grade 0 to 1 or baseline; either resume at a reduced dose or discontinue depending on severity and persistence of hepatotoxicity. Permanently discontinue for hepatic failure.
RENAL IMPAIRMENT OR FAILURE:
-Grade 3 or 4: Withhold until improves to Grade 0 to 1 or baseline; resume at a reduced dose or discontinue depending on severity and persistence of renal impairment.
PROTEINURIA:
-Two grams or greater proteinuria in 24 hours: Withhold until less than or equal to 2 grams of proteinuria per 24 hours; resume at a reduced dose. Permanently discontinue for nephrotic syndrome.
GI PERFORATION:
-Any Grade: Permanently discontinue therapy.
QT PROLONGATION:
-Greater than 500 ms or greater than 60 ms increase from baseline: Withhold until improves to less than or equal to 480 ms or baseline; resume at a reduced dose.
REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME (RPLS):
-Any Grade: Withhold until fully resolved; resume at a reduced dose or discontinue depending on severity and persistence of neurologic symptoms.
OTHER ADVERSE REACTIONS:
-Persistent or intolerable Grade 2 or 3 adverse reaction or Grade 4 laboratory abnormality: Withhold until improves to Grade 0 to 1 or baseline; resume at reduced dose.
-Grade 4 adverse reaction: Permanently discontinue therapy.

Precautions

CONTRAINDICATIONS:
-None

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not expected to be dialyzable due to its high plasma protein binding.

Other Comments

Administration advice:
-This drug can be given with or without food.
-This drug should be taken at the same time each day.
-If a dose is missed and cannot be taken within 12 hours, skip that dose and take the next dose at the usual time.

Monitoring:
-Cardiovascular: Blood pressure (prior to treatment, after 1 week, every 2 weeks for the first 2 months, then at least monthly), signs and symptoms of cardiac decompensation, ECG, electrolytes
-Endocrine: TSH levels (monthly)
-Hepatic: ALT, AST (prior to treatment, every 2 weeks for the first 2 months, then at least monthly)
-Metabolic: Serum electrolytes, blood calcium levels (at least monthly)
-Renal: Proteinuria (prior to treatment and periodically after initiation)

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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