Lenvatinib for the treatment of kidney cancer

ABSTRACT

Introduction: Sequential administration of single targeted agents has evolved as the dominant paradigm in advanced RCC treatment. Lenvatinib plus everolimus is the first combination therapy in advanced RCC to show improvement in efficacy compared to monotherapy in advanced RCC while maintaining manageable toxicity profile.

Areas covered: This review gives a brief overview of the contemporary clinical data on lenvatinib including its mechanism of action, pharmacokinetics, efficacy and safety profile in combination with everolimus. The clinical applications of lenvatinib in combination with everolimus are addressed within the context of the current competitive therapeutic landscape of RCC.

Expert commentary: Lenvatinib is a new VEGF receptor-targeted tyrosine kinase inhibitor approved in combination with everolimus for second-line therapy in patients with advanced renal cell carcinoma progressing on a first-line VEGF receptor-targeted tyrosine kinase inhibitor. The combination of lenvatinib with everolimus significantly improved progression-free survival compared with everolimus with a hazard ratio of 0.40 and increased objective response to 43%. Optimal sequence of therapy targeting the tumor and the immune system remains a challenge and further investigation is warranted.

KEYWORDS:

• Lenvatinib
• everolimus
• metastatic renal cell carcinoma
• second-line treatment
• targeted therapy

Declaration of interest

H Studentova reports acting in an advisory role and receiving honoraria for speeches and travel support from Eisai, Novartis, Pfizer, and Ipsen. D Vitaskova reports acting in an advisory role and receiving honoraria for speeches and travel support from Eisai, Pfizer, Ipsen, Roche, and Bristol-Myers Squibb. B Melichar reports acting in an advisory role and receiving honoraria for speeches and travel support from Eisai, Novartis, Roche, Pfizer, Bristol-Myers Squibb, Bayer, Ipsen, Merck, MSD, Astellas, Amgen, AstraZeneca, Sanofi, and Janssen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. A reviewer on this manuscript has disclosed that they have acted as a consultant and received honoraria for being on the advisory board from Eisai and Novartis, who are the manufacturers of lenvatinib and everolimus respectively. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

The work was supported in part by the Czech Ministry of Education [grant NPS I LO1304 and DRO UP 61989592] and by the Czech Science Foundation [grant No. 17-16614S].