[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [VEGFR multikinase inhibitors](https://durgical.com/en/pharmacology/classes/vegfr-multikinase-inhibitors/) › Lenvatinib # Lenvatinib ## VEGFR multikinase inhibitors? VEGFR multikinase inhibitors ## High alert? An error with this medicine can cause serious harm: double checks and protocols are used. ## Pregnancy: avoid? Avoid in pregnancy. Can harm the fetus: a pregnancy test is done before starting, effective contraception is used during treatment and for a time afterwards (by women and by men… A broad multikinase inhibitor (VEGFR, FGFR, PDGFR, KIT, RET) for thyroid, liver, kidney and endometrial cancer. Watch BP, QT and liver. Updated Nov 1, 2026 Also called: lenvatinib mesylate ## Quick facts **Group** [VEGFR multikinase inhibitors](https://durgical.com/en/pharmacology/classes/vegfr-multikinase-inhibitors/) **Target** VEGFR1-3, FGFR, PDGFR, KIT and RET tyrosine kinases **Used for** Unresectable hepatocellular carcinoma **Key effects** Hypertension · Fatigue · Diarrhoea **Monitor** Blood pressure regularly · ECG and electrolytes **ATC** L01EX08 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ✂**VEGFR1-3, FGFR, PDGFR, KIT and RET tyrosine kinases**Lenvatinib ⓘ The figure shows lenvatinib in the ATP pocket of the human VEGFR2 (KDR) kinase domain. **Target in 3D:** VEGFR1-3, FGFR, PDGFR, KIT and RET tyrosine kinases. PDB structure 3WZD (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3WZD) · Drag to rotate · pinch to zoom Lenvatinib blocks the kinases of VEGFR1-3 and FGFR, which drive angiogenesis, and of PDGFR, KIT and RET, which drive tumour growth. Combined with pembrolizumab it adds anti-angiogenic action to immune checkpoint blockade in endometrial and kidney cancer. - Blocks VEGFR1-3 and FGFR: angiogenesis stops - Blocks PDGFR, KIT and RET: tumour growth signals stop - Paired with pembrolizumab or everolimus in some cancers ## Indications - Recurrent or metastatic differentiated thyroid cancer that no longer responds to radioactive iodine. [Thyroid cancer (papillary) →](https://durgical.com/en/conditions/thyroid-cancer/) - Unresectable hepatocellular carcinoma, as first treatment. [Hepatocellular carcinoma →](https://durgical.com/en/conditions/hepatocellular-carcinoma/) - Advanced renal cell carcinoma: first line with pembrolizumab, or with everolimus after anti-angiogenic therapy. [Renal cell carcinoma →](https://durgical.com/en/conditions/renal-cell-carcinoma/) - Advanced endometrial carcinoma that is not MSI-high or mismatch repair-deficient, after systemic therapy, with pembrolizumab. [Endometrial cancer →](https://durgical.com/en/conditions/endometrial-cancer/) ## Adverse effects ### Common - Hypertension - Fatigue, decreased appetite, weight loss - Diarrhoea, nausea, mouth sores - Hand-foot skin reaction (red, painful, peeling palms and soles) - Hoarseness, joint and muscle pain, headache ### Serious (rare, important) - Hepatotoxicity - QT prolongation - Cardiac dysfunction - Arterial thrombosis (heart attack, stroke) and bleeding - Gastrointestinal perforation - Impaired wound healing; osteonecrosis of the jaw ## Contraindications - No absolute contraindications in the label apart from hypersensitivity; see the warnings ## Key interactions **Other QT-prolonging drugs (some antiarrhythmics, macrolides, antipsychotics)** Additive risk of QT prolongation and arrhythmia. **Bisphosphonates or denosumab (osteoporosis drugs)** Higher risk of osteonecrosis of the jaw. **Anticoagulants and antiplatelet drugs** Add to its bleeding risk. ## What is monitored - Blood pressure regularly - ECG and electrolytes - Liver tests and other laboratory tests - Dental examination before starting ## Administration and safety - Oral capsules swallowed whole; if swallowing is hard, the label describes dissolving them in water or apple juice, and giving them by feeding tube. - Stopped before planned surgery or dental surgery and restarted only when the wound has healed, as the doctor directs. ## Pregnancy and breastfeeding Avoid in pregnancy. Can harm the fetus: a pregnancy test is done before starting, effective contraception is used during treatment and for a time afterwards (by women and by men with partners who could conceive), and breastfeeding is avoided. ## Nursing care - Measure blood pressure at every visit and teach home monitoring if ordered. - Review the medication list for QT-prolonging drugs and osteoporosis drugs. - Teach to report bleeding, black stools, vomiting blood, severe abdominal pain, chest pain or stroke symptoms at once. - Advise a dental check before starting and to tell any dentist or surgeon about the drug. ## Pharmacokinetics **Absorption** Oral capsules, once daily, with or without food. **Metabolism** Liver, CYP3A. **Half-life** About 28 hours. ## Memory aid «LENVAtinib, the wide LENS»: VEGFR + FGFR + PDGFR + KIT + RET; the partner of pembrolizumab in endometrial cancer. ## Test yourself Think of the answer, then tap the question to see it. ## Which thyroid cancers are treated with lenvatinib? Recurrent or metastatic differentiated thyroid cancer that no longer responds to radioactive iodine. ## Which immunotherapy is combined with lenvatinib in endometrial cancer? Pembrolizumab. ## Which jaw complication is a warning for lenvatinib? Osteonecrosis of the jaw, more likely with dental procedures and osteoporosis drugs. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/lenvatinib/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **High alert** An error with this medicine can cause serious harm: double checks and protocols are used. **Pregnancy: avoid** Avoid in pregnancy. Can harm the fetus: a pregnancy test is done before starting, effective contraception is used during treatment and for a time afterwards (by women and by men… ## Connections ## Related drugs 4 - [Sorafenib](https://durgical.com/en/pharmacology/sorafenib/) - [Pembrolizumab](https://durgical.com/en/pharmacology/pembrolizumab/) - [Everolimus](https://durgical.com/en/pharmacology/everolimus/) - [Cabozantinib](https://durgical.com/en/pharmacology/cabozantinib/) ## Related conditions 4 - [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/) - [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/) - [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/) - [Endometrial cancer](https://durgical.com/en/conditions/endometrial-cancer/) [← Back to the class: VEGFR multikinase inhibitors](https://durgical.com/en/pharmacology/classes/vegfr-multikinase-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Lenvatinib: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a615015.html) (MedlinePlus (U.S. National Library of Medicine), 2023); [Lenvatinib Mesylate - NCI](https://www.cancer.gov/about-cancer/treatment/drugs/lenvatinibmesylate) (National Cancer Institute, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01EX08) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/lenvatinib/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/lenvatinib/