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Lenvatinib Hypertension/Proteinuria — SCE Medical Oncology MCQ

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ModerateGynaecological CancersLenvatinib Hypertension/ProteinuriaSCE Medical Oncology

A 60-year-old woman with recurrent endometrial cancer (pMMR, p53-mutant) on lenvatinib + pembrolizumab develops grade 3 hypertension (BP 180/110 mmHg) and grade 2 proteinuria. What is the cause and management?

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Correct answer: B — Lenvatinib (VEGFR-TKI) class-effect toxicity — manage with antihypertensives (ACEi/ARB preferred for concurrent proteinuria), dose reduce lenvatinib if hypertension is persistent despite optimal medical therapy

Hypertension and proteinuria are VEGFR-TKI class effects (lenvatinib, cabozantinib, sunitinib). In the lenvatinib + pembrolizumab combination, the hypertension/proteinuria is attributable to lenvatinib (not pembrolizumab). ACE inhibitors or ARBs are preferred antihypertensives because they also reduce proteinuria. Lenvatinib dose reduction (20→14→10 mg) is used for persistent grade 3 hypertension despite optimal medical therapy. Proteinuria >2 g/24h warrants lenvatinib hold; nephrotic range warrants permanent discontinuation.

Reference: BNF Lenvatinib; NICE TA902; KEYNOTE-775 safety