The importance of early-stage blood pressure control in thyroid cancer patients treated with lenvatinib from the perspective of dose intensity

Purpose Lenvatinib (LEN) is a multikinase inhibitor that strongly inhibits tyrosine kinase receptors, especially VEGFR-2, which can cause hypertension, as well as strong tumor shrinkage. Though control of any side effects (SEs) is important for maintaining dose intensity (DI), hypertension is particularly important, because blood pressure (BP) can change quickly and respond to LEN administration and withdrawal, and it can be controlled with antihypertensive medications. Focusing on the early phase of treatment, the effect of BP 8 weeks after LEN initiation (BP 8w ) on DI at 8 weeks (DI 8w ) was investigated. Methods The subjects were 85 thyroid cancer patients who started LEN at 24 mg/day and continued for ≥8 weeks. The BP at the start of LEN (BP base ), BP 8w grade, and DI 8w were examined. Results Median (range) systolic BP changed significantly from BP base of 117 (84–167) mmHg to BP 8w of 134 (103–168) mmHg ( p <0.001). Antihypertensive treatment at baseline, systolic BP base , and male sex were related to higher DI 8w on multivariate analysis. The median DI 8w of the 23 patients who required dose modification due to hypertension was 20.2 mg/day ( n =6) in grade 1, 15.8 mg/day ( n =13) in grade 2, and 14.5 mg/day ( n =4) in grade 3, showing a trend toward lower DI 8w as the grade level increased. Conclusion LEN can increase BP by 20 mmHg at 8 weeks even with intensive antihypertensive management. Baseline antihypertensive treatment and BP base can affect DI 8w . A higher DI 8w may be achieved by aiming for a low 8-week BP with more intensive antihypertensive therapy after LEN initiation.