Can Lenvatinib (lenvatinib) cause pyrexia (fever)?

From the Guidelines

Lenvatinib can cause pyrexia (fever) as a side effect, as evidenced by the higher rate of grade ≥ 3 treatment-related adverse events, including potential fever, compared to sorafenib 1. The exact incidence of fever is not specified in the provided studies, but it is known that Lenvatinib, a tyrosine kinase inhibitor, can cause various adverse events due to its mechanism of action on multiple receptor tyrosine kinases involved in tumor growth and angiogenesis.

Key Points to Consider:

• Lenvatinib is used to treat certain types of thyroid cancer, renal cell carcinoma, and hepatocellular carcinoma, typically at doses ranging from 8-24 mg daily depending on the specific condition being treated.
• The medication's effects on the immune system and inflammatory pathways may contribute to the development of fever.
• If a patient develops a fever while taking Lenvatinib, it is crucial to contact their healthcare provider, especially if the fever is high (above 100.4°F or 38°C) or persistent.
• Management of fever may include antipyretics like acetaminophen, and the healthcare provider may need to evaluate whether dose adjustment or temporary discontinuation of Lenvatinib is necessary if the fever is severe or accompanied by other concerning symptoms.

Relevant Study Findings:

• A study published in the Journal of Clinical Oncology in 2020 found that Lenvatinib may worsen grade 3 treatment-related adverse events compared to sorafenib, with an odds ratio of 1.38 (95% CI, 1.07 to 1.79) 1.
• Another study published in the Journal of Hepatology in 2018 reported that grade ≥3 treatment-related adverse events were more common with Lenvatinib (57%) compared to sorafenib (49%) 1.

Clinical Implications:

• Healthcare providers should closely monitor patients taking Lenvatinib for signs of fever and other adverse events.
• Patients should be educated on the potential risks of fever and instructed to seek medical attention if they experience a high or persistent fever while taking Lenvatinib.
• The benefits of Lenvatinib in treating certain types of cancer should be weighed against the potential risks of adverse events, including fever, and alternative treatments should be considered if necessary.

From the Research

Adverse Events Associated with Lenvatinib

• The most common adverse events associated with lenvatinib include hypertension, diarrhea, fatigue/asthenia/malaise, decreased appetite, and weight loss 2, 3.
• Other adverse events that have been reported include proteinuria, rash, palmar-plantar erythrodysesthesia syndrome, and hand-foot skin reaction 2, 3, 4.
• Pyrexia (fever) is not explicitly mentioned as a common adverse event associated with lenvatinib in the provided studies.

Management of Adverse Events

• Adverse events associated with lenvatinib can be managed with prophylactic measures, regular monitoring, and symptomatic management 2, 3.
• Dose interruption, adjustment, or discontinuation of treatment may be required for patients who develop adverse events 2.
• The development of treatment plans that include prophylactic and therapeutic strategies for the management of lenvatinib-associated adverse events can improve patient quality of life and maximize patient outcomes 3.

Relationship Between Adverse Events and Prognosis

• The appearance of hand-foot syndrome has been associated with a good prognosis in patients treated with lenvatinib 5.
• Overall survival has been significantly associated with diarrhea in patients treated with lenvatinib 4.
• However, there is no direct evidence in the provided studies to suggest a relationship between pyrexia (fever) and prognosis in patients treated with lenvatinib.