Lenvatinib-induced renal failure: two first-time case reports and review of literature

• Published in: Expert opinion on drug metabolism & toxicology Vol. 14; no. 4; p. 379
• Main Authors: Cavalieri, Stefano, Cosmai, Laura, Genderini, Augusto, Nebuloni, Manuela, Tosoni, Antonella, Favales, Federica, Pistillo, Paola, Bergamini, Cristiana, Bossi, Paolo, Licitra, Lisa, Locati, Laura D, Alfieri, Salvatore
• Format: Journal Article
• Language: English
• Published: England 03.04.2018
• Subjects: Adult; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Carcinoma, Adenoid Cystic - drug therapy; Carcinoma, Papillary - drug therapy; Female; Humans; Male; Middle Aged; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - adverse effects; Proteinuria - etiology; Quinolines - administration & dosage; Quinolines - adverse effects; Renal Insufficiency - chemically induced; Salivary Gland Neoplasms - drug therapy; Thyroid Cancer, Papillary; Thyroid Neoplasms - drug therapy; toxicity; salivary gland cancer; lenvatinib; VEGF; proteinuria; VEGFR; renal failure; nephropathy; thyroid cancer; Antiangiogenic
• ISSN: 1744-7607
• DOI: 10.1080/17425255.2018.1461839

Lenvatinib (LEN) is a multi-kinase anti-angiogenic drug recently approved in several cancers. LEN is not easily manageable due to its complex safety profile. Proteinuria and renal failure (RF) were reported among the most frequent LEN-induced adverse events (AEs), often leading to discontinuations or dose modifications. Understanding the pathogenesis of these AEs could ameliorate the management of LEN-induced renal toxicity. Areas covered: We present two cases of LEN-induced renal failure (LIRF) with different pathogenesis. 1) LIRF with severe proteinuria in a man treated for a metastatic papillary thyroid carcinoma. Kidney biopsy showed a glomerular damage secondary to LEN, having excluded other causes of RF. 2) LIRF without proteinuria in a woman with metastatic adenoid cystic carcinoma of minor salivary gland. A tubulointerstitial nephropathy was supposed by clinical evaluation and laboratory tests. Effective management was obtained by oral steroids without interrupting LEN. Expert opinion: The case 1 presented for the first time the histological picture of LIRF with a classical glomerular damage leading to secondary proteinuria and tubular failure. Case 2 showed an alternative LIRF pattern of likely tubulointerstitial injury without proteinuria. These reports reflect two sides of the same coin, both to be considered in case of LIRF.