Ps-c20-2: hypertension due to lenvatinib induction

Background: Lenvatinib (LEN) is a multi-kinase inhibitor that blocks vascular endothelial growth factor and other factors and is often associated with hypertension due to its mechanism of action. However, there is insufficient information on LEN-related hypertension. The purpose of this study was to compare the degree, timing, and risk of developing Grade 2 or higher hypertension after LEN induction with those who did not develop. Methods: Of 36 patients who newly started LEN between January 2021 and March 2022 at our hospital, 33 patients were included, excluding those younger than 20 years and those who were introduced as outpatients. Results: The median age was 73 years, 57.6% were female, and 54.5% had hypertension. Hypertension was observed in 23 patients (69.7%) after the start of LEN, and 13 patients (39.4%) had Grade 3 or higher hypertension. The most common time of onset of hypertension was the day of LEN induction in 12 patients (52.2%). There were no differences in age, BMI, underlying disease, or stage of disease between the hypertension-onset group and the non-hypertension-onset group. The hypertension-onset group was significantly more likely to be female, have thyroid cancer, receive a higher initial dose of LEN, and have higher pre-start blood pressure. The mean blood pressure before LEN administration was 124/77 mmHg, which was significantly increased to 139/84 mmHg the morning after the day of administration (P < 0.00001). Systolic blood pressure was also significantly higher in the non-hypertensive group (P = 0.02), 100 mmHg before start vs. 116 mmHg the next morning. Ca antagonists were most frequently prescribed for hypertension. Conclusion: Early induction of LEN is associated with a high risk of blood pressure fluctuations and requires caution.