Impact of lenvatinib-induced proteinuria and renal dysfunction in patients with thyroid cancer
Yuma Shibutani1,2, Shinya Suzuki1,2, Atsunobu Sagara2
1Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Background:
Proteinuria is the most frequent adverse event of lenvatinib use. However, the association between lenvatinib-induced proteinuria and renal dysfunction remains unclear.
Methods:
We retrospectively reviewed medical records of patients with thyroid cancer without proteinuria treated with lenvatinib as a first-line systemic therapy at the initiation of treatment to assess the association between lenvatinib-induced proteinuria and renal function and the risk factors for the development of ≥3+ proteinuria on a dipstick test. Proteinuria was assessed by the dipstick test throughout the treatment in all cases.
Results:
Of the 76 patients, 39 developed ≤2+ proteinuria (low proteinuria group) and 37 developed ≥3+ proteinuria (high proteinuria group). There was no significant difference in estimated glomerular filtration rate (eGFR) between high and low proteinuria groups at each time point, but there was a trend toward a significant decrease in eGFR of -9.3 ml/min/1.73 m2 in all patients after 2 years of treatment. The percentage of change in eGFR (ΔeGFR) significantly decreased in the high proteinuria group compared to that in the low proteinuria group (ΔeGFR: -6.8% vs. -17.2%, p=0.04). However, there was no significant difference in development of severe renal dysfunction with eGFR <30 ml/min/1.73 m2 between the two groups. Moreover, no patients permanently discontinued treatment because of renal dysfunction in both groups. Furthermore, renal function after completion of lenvatinib was reversible.
Conclusions:
There was no association between the degree of lenvatinib-induced proteinuria and renal function. Therefore, treatment should be continued with attention to renal function, regardless of the degree of proteinuria.
Insights
Lenvatinib-induced proteinuria in thyroid cancer patients did not correlate with renal dysfunction. Continued lenvatinib treatment is advised, monitoring renal function regardless of proteinuria levels.
Area of Science:
- Oncology
- Nephrology
- Pharmacology
Background:
- Proteinuria is a common side effect of lenvatinib treatment.
- The relationship between lenvatinib-induced proteinuria and kidney dysfunction is not well understood.
Purpose of the Study:
- To investigate the association between lenvatinib-induced proteinuria and renal function in thyroid cancer patients.
- To identify risk factors for developing significant proteinuria during lenvatinib therapy.
Main Methods:
- Retrospective review of medical records of 76 thyroid cancer patients treated with lenvatinib.
- Assessment of proteinuria using dipstick tests and monitoring of estimated glomerular filtration rate (eGFR).
- Patients were categorized into low (≤2+) and high (≥3+) proteinuria groups.
Main Results:
- No significant difference in eGFR between high and low proteinuria groups at any time point.
- A trend towards decreased eGFR was observed in all patients after two years.
- The high proteinuria group showed a significantly greater decrease in eGFR percentage compared to the low proteinuria group, but severe renal dysfunction did not differ between groups.
Conclusions:
- The degree of lenvatinib-induced proteinuria is not associated with renal dysfunction.
- Lenvatinib treatment can be continued while monitoring renal function, irrespective of proteinuria severity.
- Renal function was reversible after lenvatinib discontinuation.
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