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Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?

Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?
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What starting dose of lenvatinib do you use when using in combination with pembrolizumab for advanced endometrial cancer?

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3 Answers
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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on · Updated on

For the first part of the question, "Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?" The strategy of administering lenvatinib therapy by starting at the established...

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Gynecologic Oncology · UCSD Moores Cancer Center
Answered on

The dosing of lenvatinib has been greatly debated since the initial FDA approval of the combination regimen in the endometrial cancer space. I start at 20 mg unless the patient has an existing medical comorbidity that mandates a lower starting dose (i.e. hepatic disease). Importantly, however, I rem...

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Gynecologic Oncology · UCLA David Geffen School of Medicine/UCLA Medical Center
Answered on

I start at 20 mg for most patients but monitor for side effects closely in the first couple of months and am quick to dose reduce. I do give strict blood pressure monitoring instructions as well as strict precautions regarding diarrhea. If severe renal or hepatic impairment, the starting dose is 10 ...

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