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TKI Toxicity — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyTKI ToxicitySCE Medical Oncology

A 58-year-old woman on lenvatinib for thyroid cancer develops persistent grade 3 diarrhoea despite loperamide optimisation. What pharmacological management is appropriate?

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Correct answer: CDose reduction of lenvatinib (20 mg → 14 mg → 10 mg daily)

Diarrhoea is one of the most common TKI class-effect adverse events (distinct from immune-related diarrhoea). Management of TKI-associated diarrhoea focuses on antidiarrhoeal agents (loperamide), dietary modification, and stepwise dose reduction if grade ≥2 persists. Lenvatinib dose modifications follow the 20 mg → 14 mg → 10 mg reduction scheme. Infliximab and systemic corticosteroids are NOT appropriate for TKI-induced diarrhoea (they address immune-mediated, not direct drug-effect diarrhoea). Treatment interruption with dose reduction is key.

Reference: BNF Lenvatinib monograph; NICE TA535 Lenvatinib; ESMO 2024 Supportive Care Guidelines