Sustained erythrocytosis due to the use of Lenvatinib

Abstract

Introduction Tyrosine kinase inhibitors have become the mainstay of treatment for many malignancies, but their use can be accompanied by unusual and often puzzling side effects. Case report We describe herein a 64-year-old patient who developed a robust and sustained erythrocytosis shortly after starting treatment with lenvatinib. Our patient also experienced elevated blood pressure, mucositis, and hand-foot syndrome that are not uncommonly seen with this agent. The clinico-laboratory work-up suggested that lenvatinib was the likely culprit in this case. Management & Outcome Lenvatinib had to be discontinued due to suboptimal tolerance and a short-lived response. With the discontinuation of lenvatinib, hemoglobin trended downwards and subsequently resolved. A score of 6 on the Naranjo nomogram supported a probable causality relationship between lenvatinib and the observed erythrocytosis. Discussion Erythrocytosis has previously been described with sunitinub, sorafenib and pazopanib. The exact mechanism of this phenomenon is not known. It might increase the risk of venous and arterial thromboses in cancer patients that are already in a hypercoagulable state due to cancer itself. In addition, laboratory work-up for polycythemia may prove extensive and costly. Therefore, clinicians need to be aware of this important side effect of tyrosine kinase inhibitors.

Progressive erythrocytosis under lenvatinib treatment in patients with advanced hepatocellular carcinoma

“…Several case reports of erythrocytosis occurring during antiangiogenic treatments in cancer (cediranib, vandetanib, axitinib, pazopanib, sunitinib, sorafenib or bevacizumab) have been published [ 14 – 22 ]. However, the high frequency of this AE (87%) is striking in the present series, despite use of the classical dosage.…”

Lenvatinib-Associated Erythrocytosis

“…9 One case has been reported so far of a patient on lenvatinib developing sustained erythrocytosis, requiring discontinuation of the drug. 10 Multiple possibilities of TKIs causing erythrocytosis have been proposed in the past, and most authors speculate an enhanced erythropoietin production because of VEGF blockage causing hypoxia-induced elements and rebound erythropoiesis. 11 A temporal relationship of lenvatinib and erythrocytosis indicates a direct causation versus neoplastic effects of cancer itself.…”

Nanotechnology strategies for hepatocellular carcinoma diagnosis and treatment

“…179 However, their effects are limited by their side effects and low bioavailability. 180 Peptide nanogels with stimulatory response were developed for LEN delivery with good tumor suppression effect and few side effects. 181 LPs carrying SRF and ganoderic acid are used as anti-HCC agents.…”