Lenvatinib is a substrate of cytochrome P450 (CYP) 3A and ATP-binding cassette (ABC) transporters. In this study, we aimed to evaluate how
CYP3A4/5
and
ABC
transporter polymorphisms affected the mean steady-state dose-adjusted plasma trough concentrations (C
0
) of lenvatinib in a cohort of 40 Japanese patients with thyroid cancer.
CYP3A4
20230G > A (
*1G
),
CYP3A5
6986A > G (
*3
),
ABCB1
1236C > T,
ABCB1
2677G > T/A,
ABCB1
3435C > T,
ABCC2
−24C > T, and
ABCG2
421C > A genotypes were determined using polymerase chain reaction-restriction fragment length polymorphism. In univariate analysis, there were no significant differences in the mean dose-adjusted C
0
values of lenvatinib between the
ABCB1
,
ABCG2
, and
CYP3A5
genotypes. However, the mean dose-adjusted C
0
values of lenvatinib in patients with the
CYP3A4*1/*1
genotype and
ABCC2
−24T allele were significantly higher than those in patients with the
CYP3A4*1G
allele and −24C/C genotype, respectively (
P
= 0.018 and 0.036, respectively). In multivariate analysis,
CYP3A4
genotype and total bilirubin were independent factors influencing the dose-adjusted C
0
of lenvatinib (
P
= 0.010 and 0.046, respectively). No significant differences were found in the incidence rates of hypertension, proteinuria, and hand-foot syndrome following treatment with lenvatinib between the genotypes of
CYP3A4/5
and
ABC
transporters. Lenvatinib pharmacokinetics were significantly influenced by the
CYP3A4*1G
polymorphism. If the target plasma concentration of lenvatinib for efficacy or toxicity is determined, elucidation of the details of the
CYP3A4*1G
genotype may facilitate decision-making related to the appropriate initial lenvatinib dosage to achieve optimal plasma concentrations.