Lenvatinib: A narrative drug review

Abstract

The discovery and clinical efficacy of imatinib in chronic myeloid leukemia opened a new and interesting avenue of oral small-molecule tyrosine kinase inhibitors. Thereafter, several such molecules with efficacy across multiple tumor types have been discovered. One of the oral multi-kinase inhibitors is lenvatinib, which started its journey in 2008 when it showed efficacy on stem cells in the laboratory setting and was first approved by the United States Food and Drug Administration in August 2015 for the management of radioiodine-refractory differentiated thyroid cancer. Since then, it has been approved for hepatocellular, endometrial, and renal cell carcinomas, and many more trials are underway for lenvatinib in multiple solid tumors, either alone or in combination with immunotherapy. In addition to the robust data on the efficacy of this drug, it is known for its tolerability with different dosing schedules in different tumor types, a feature unique to this drug. Therefore, an in-depth understanding of its mechanism of action, pharmacokinetics, pharmacodynamics, dosage in different tumor types, expected side effects, and predictors of response will go a long way in its safe and appropriate use in the clinics. In this review, we aim to summarize and collate these data in a reader-friendly manner, thus making it a ready reckoner for lenvatinib. We searched the PubMed database for full-text articles on lenvatinib published in the last 10 years using the search terms “lenvatinib,” “hepatocellular carcinoma,” renal cell carcinoma,” “thyroid carcinoma,” “and “endometrial carcinoma”. A total of 1053 studies were identified, of which 60 were included in this review.