Lenvatinib (Lenvima, Kisplyx)

Lenvatinib is a targeted cancer drug. It is also known as Lenvima and Kisplyx. You pronounce lenvatinib as len-va-tih-nib. 

It is a treatment for a number of different cancer types. 

Lenvatinib is sometimes given in combination with an immunotherapy drug called pembrolizumab.

For advanced kidney cancer, you usually have lenvatinib with another cancer drug called everolimus. 

How does lenvatinib work?

Lenvatinib is a type of targeted drug called a cancer growth blocker. It works in 2 ways. It stops:

• signals that tell cancer cells to grow
• cancer cells from forming new blood vessels, which they need to keep growing

How do you have lenvatinib?

You have lenvatinib as capsules that you swallow whole, once a day.

Taking your capsules

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have lenvatinib?

You usually take lenvatinib for as long as it is helping you, and the side effects aren’t too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of lenvatinib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

You may also have bleeding in different parts of your body such as the lungs, brain and tummy (abdomen). This can be life threatening. Speak to your doctor or nurse straightway in you have any signs of bleeding.

Changes to your blood pressure 

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Constipation or diarrhoea 

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Difficulty speaking

You might have difficulty speaking or a hoarse voice. Speak to your doctor or nurse if you have this. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Indigestion

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Dry mouth

A dry mouth is also called xerostomia (pronounced zero-stow-mee-a). Talk to your healthcare team if you have this. They can give you artificial saliva to help with a dry mouth. It can also help to drink plenty of fluids.

Changes to levels of thyroid hormones

The levels of your thyroid hormones may change. You may feel tired or cold, gain weight, feel sad or depressed, or your voice may deepen. You will have regular blood tests to check your thyroid hormone levels.

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

Soreness, redness and peeling on palms or soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Hair loss

Your hair may thin but you’re unlikely to lose all your hair. It is almost always temporary and your hair will grow back when you finish your treatment.

Pain in different parts of your body

You may have pain in different parts of your body such as your tummy (abdomen), back, muscles, bones and joints. Speak to your treatment team if you have this. They can give you painkillers to help with this.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Swollen hands and legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Protein in your urine

Your nurse regularly checks your urine for protein during treatment. You may need further tests to check how well your kidneys are working.

Urinary tract infection (UTI)

You might get a urinary tract infection. Let your doctor know if you have trouble passing urine or if it's painful or stings when you pass urine. Or if your urine is smelly or darker than usual. 

Changes in the levels of salts and minerals in your body

This treatment can change the levels of potassium, magnesium, calcium, creatinine and cholesterol in your blood. You have regular blood tests to check for this.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• loss of fluid in your body (dehydration)
• high levels of the enzymes amylase and lipase in your body. You have regular blood tests to check for this
• severe liver changes that can be life threatening if left untreated
• inflammation of the gallbladder (cholecystitis)
• a blocked blood vessel in your lungs which can cause shortness of breath and chest pain
• an abnormal opening (fistula) between your bowel and back passage
• passing wind (flatulence)
• changes to the way your heart works and a heart attack
• loss of blood flow to a part of your brain (stroke)
• changes to how well your kidneys are working - you will have regular blood tests to check for this
• a blood clot in the brain, causing a stroke

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• problems with wound healing
• inflammation of the liver or pancreas
• a build up of air between the outside of your lung and your ribcage which can cause shortness of breath
• collection of pus (abscess) under the skin around your back passage
• osteonecrosis of the jaw
• inflammation of the bowel (colitis)
• a rare disorder of the nerves causing headache, fits, confusion and changes in vision. This is called posterior reversible encephalopathy syndrome (PRES). Contact your health care team straight away. This condition is reversible
• kidney problems that can cause swollen ankles and hands, shortness of breath and sickness
• loss of movement or sensation in one of your limbs

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least a month afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.