Lenvatinib, as a multi-target tyrosine kinase inhibitor, should be given special attention to adverse reactions such as hypertension, proteinuria, and thyroid dysfunction during treatment.

1. Hypertension management

The incidence of hypertension during treatment with lenvatinib is as high as 73%, with a median onset time of 16 days. Blood pressure needs to be monitored weekly until it stabilizes, and then changed to every 2-4 weeks. Grade 3 hypertension (systolic blood pressure ≥ 160mmHg or diastolic blood pressure ≥ 100mmHg) should be temporarily discontinued, controlled, and reduced before recovery; Grade 4 hypertension requires permanent discontinuation of medication. Suggest combining antihypertensive drugs for treatment, with calcium channel blockers being the preferred choice.

2. Proteinuria monitoring

The incidence of proteinuria is 31%, with a median onset time of 5.9 months. Regular urine tests before and during treatment, if there is a grade 2 (urinary protein 2+or 24-hour urinary protein 1-3.5g), it should be reduced; Grade 3 (24-hour urine protein>3.5g) should be temporarily discontinued until it recovers to below Grade 1. Renal syndrome grade proteinuria requires permanent discontinuation of medication.

3. Abnormal thyroid function

The incidence of hypothyroidism is about 21%. TSH levels should be monitored before treatment and every 4-8 weeks. Symptomatic hypothyroidism requires thyroid hormone replacement therapy. Patients undergoing thyroid stimulating hormone suppression therapy need to monitor TSH more frequently.

4. Other important precautions

Monitoring of QT interval prolongation and cardiac dysfunction is necessary in terms of cardiac toxicity; Patients at risk of bleeding should avoid using anticoagulants in combination; Abnormal liver function requires regular testing of ALT/AST; Patients of childbearing age need to take effective contraceptive measures; Medication should be suspended during the wound healing period.

5. Principle of dose adjustment

First occurrence of grade 3 toxicity, medication was temporarily suspended until ≤ grade 1, and then reduced and resumed; Relapse of grade 3 or occurrence of grade 4 toxicity requires permanent discontinuation of medication. The recommended starting dose for patients with hepatocellular carcinoma should be adjusted according to body weight (12mg/day for those weighing ≥ 60kg, 8mg/day for those weighing<60kg).