® LENVIMA
Treatment for hepatocellular carcinoma (HCC)
This booklet is for people who have been prescribed LENVIMA for the treatment of hepatocellular carcinoma (HCC), which is a type of liver cancer. Inside you will find answers to some common questions about LENVIMA treatment.
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Contents
About LENVIMA 3 Dosing 4 Ongoing use 5 Side-effects 6
This booklet is intended as a guide and does not replace the advice of a healthcare professional. Please consult your doctor for further information.
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What is LENVIMA?
LENVIMA is an anti-cancer medicine that contains the active ingredient lenvatinib. It belongs to a family of medicines called multiple receptor tyrosine kinase inhibitors.
When is LENVIMA used?
LENVIMA is used for the treatment of liver cancer, also called hepatocellular carcinoma (HCC), when the cancer has advanced and cannot be surgically removed.
How does LENVIMA work?
LENVIMA may work by slowing down the rate of growth of cancer cells. It may also cut off the blood supply that keeps cancer cells growing.
LENVIMA does this by blocking the activity of proteins called tyrosine kinases. Tyrosine kinases are involved in the growth of cancer cells as well as the development of new blood vessels that help cancers grow.
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How is LENVIMA taken?
LENVIMA is available in capsules that you will need to take orally daily. Take your dose at the same time each day, with or without food.
Swallow your capsules whole with a full glass of water. Do not chew, crush or split the capsules. If you’re unable to swallow the capsules whole, place them in a glass with approximately 25 mL of water or apple juice. Do not break or crush the capsules – allow them to disintegrate for at least 10 minutes and then gently stir the liquid for at least 3 minutes to dissolve the capsule shells. Swallow the suspension and then add the same amount of water or apple juice to the glass. Gently swirl it around and then swallow this extra liquid.
Do not mix more than one medicine in the glass at the same time.
It is important to follow any directions provided by your doctor or pharmacist, even if these are different from the information provided in this booklet. Check with your doctor or pharmacist if you are unsure how to take LENVIMA.
What is the correct dose?
LENVIMA is usually taken as 2 or 3 capsules that are yellowish-red in colour. Each of these capsules contains 4 mg of medicine (lenvatinib). Your doctor will tell you how many capsules to take each day.
How long will treatment last?
LENVIMA treatment can continue for as long as it is of benefit to you.
Your doctor will monitor your treatment and provide you with advice based on your personal preferences and your response to LENVIMA, including any side-effects you may be experiencing.
Do not stop taking LENVIMA or change your dose unless your doctor advises you to do so.
What if I forget to take LENVIMA?
If you forget your dose of LENVIMA, you will need to consider when your next dose is due.
If your next dose is due in 12 hours or more, take the missed dose as soon as you remember. Then take your next dose at the normal time.
If your next dose is due in less than 12 hours, skip the missed dose. Then take your next dose at the normal time.
Do not take two doses at the same time to make up for a forgotten dose. This may increase your chances of experiencing side-effects.
Will I experience side-effects with LENVIMA?
Like all anti-cancer medicines, LENVIMA can cause a number of side-effects
– however, not all patients will experience side-effects and some patients may experience very few.
Most side-effects of LENVIMA will be mild to moderate and manageable, but some may require medical attention, so it’s important to report any new symptoms to your doctor.
Do not try to manage side-effects on your own.
Depending on the side-effect, it may be necessary for your doctor to adjust your dose, delay or stop your LENVIMA treatment. Your doctor may also be able to provide advice on managing side-effects at home.
Starting dose
If you weigh 60 kilograms or more
If you weigh less than 60 kilograms
Oral dose
12 mg Once daily
Number of 4 mg capsules
Oral dose
8 mg Once daily
Number of 4 mg capsules
Please note that your doctor may have prescribed a different dose, or may reduce your dose if you experience side-effects. Ask your doctor or pharmacist if you’re unsure about the correct dose for you.
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What are the most common side-effects
of LENVIMA?
Everybody will respond to LENVIMA treatment differently. However, the most common side-effects reported during clinical trials include:
High or low blood pressure
Loss of appetite or weight loss
Feeling sick and being sick, constipation, diarrhoea, stomach pain, indigestion
Feeling sleepy (drowsiness or somnolence)
Feeling weak
Cough or hoarse voice
Swelling of the legs
Rash
Dry, sore or inflamed mouth, odd taste sensation
Swelling and inflammation of the joints, and stiff muscles, bones and joints
Feeling dizzy
Hair loss
Bleeding (most commonly nose bleeds, but may include bleeding from other sites such as blood in the urine, bruising, bleeding from the gums or gut wall)
Trouble sleeping
Increased protein in the urine
Urinary infections (increased frequency in urination and difficult or painful passing of urine)
Pain – muscle, joint, headache, back
Redness, soreness and swelling of the skin on the hands and feet (hand-foot syndrome)
Underactive thyroid (tiredness, weight gain, constipation, feeling cold, dry skin)
Low levels of sodium, potassium and calcium in blood tests
High levels of cholesterol and thyroid stimulating hormone in blood tests Decreases in the number of white blood cells
Bruising and difficulty in wound healing – signs of low level of platelets in the blood.
If you experience side-effects, including any symptoms not listed above, contact your doctor as soon as possible.
What should I know about high blood pressure?
High blood pressure (or hypertension) is a very common side-effect of LENVIMA. Just under half of all people that are taking LENVIMA for HCC will experience elevated blood pressure.
What can be done for high blood pressure?
High blood pressure needs to be treated. Your doctor may prescribe
you antihypertensive medication or change the dose of your existing antihypertensive medication to reduce your blood pressure. Uncontrolled high blood pressure can lead to serious complications, so it’s important to take this medication as instructed by your doctor.
What if I have high blood pressure before starting LENVIMA?
If you already have high blood pressure, your doctor will give you antihypertensive therapy before you start LENVIMA to bring your blood pressure into the normal range.
During treatment, your blood pressure will be monitored closely and your doctor will make adjustments to your antihypertensive medication if necessary.
Do I need to measure my own blood pressure?
Your doctor may recommend regularly monitoring your blood pressure, and may ask you to do this at home or to visit your GP or local pharmacy to have it measured.
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What should I know about fatigue?
Fatigue is one of the most common side-effects of cancer treatment and cancer itself. Its causes are poorly understood. If you become fatigued, you may feel tired, worn-out or exhausted most of the time. You may also find that sleep does not refresh you like it should.
How common is fatigue with LENVIMA?
Just under half of all people that are taking LENVIMA for HCC will experience fatigue. Generally LENVIMA causes mild to moderate fatigue, but it is important to speak with your doctor about ways you can try and manage this.
What can be done for fatigue?
Talk to your doctor and nurse if you feel fatigued. If your fatigue has an underlying cause such as anaemia or pain, treatments may be available that help.
There are also things you can do to help:
Eat regular meals and snacks for energy and drink enough fluids
Set aside some time each day for relaxation or meditation
If you have enough energy, do some gentle exercises each day
Prioritise certain activities, as you may not be able to achieve as much every day as you want to
Accept help from family, carers, friends or colleagues Organise your day to include rest breaks.
What should I know about diarrhoea?
Diarrhoea can be loose and watery bowel movements, or an increase in the number of bowel movements you have. Tell your doctor if you experience diarrhoea while on treatment.
How common is diarrhoea with LENVIMA?
Around 2 in 5 patients treated with LENVIMA for HCC will experience diarrhoea. This is mostly mild to moderate and can be managed by your doctor.
What should I do if I have diarrhoea?
Diarrhoea needs to be treated. It can usually be managed with fluids and by anti-diarrhoeal medication prescribed by your doctor.
If your diarrhoea is not controlled even after taking anti-diarrhoeal medication, contact your doctor or nurse for advice.
What can I do to reduce diarrhoea?
The following eating tips may help to reduce your diarrhoea:
Eat up to six small meals daily
Avoid caffeinated beverages, alcohol and full-strength fruit juices Avoid milk and dairy products (lactose-free milk may be okay)
Limit foods that make diarrhoea worse, including fatty or fried foods, spicy foods, raw vegetables, raw fruits and high-fibre foods like bran, whole grains, beans and legumes
Eat low-fibre meals that include things like white bread, rice, pasta, skinless chicken or fish
Eat peeled and cooked fruits and vegetables or canned or stewed fruit.
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What should I know about nausea
and vomiting?
Around 1 in 5 patients treated with LENVIMA for HCC will experience nausea, and slightly fewer than that will experience vomiting. Most of the time this is a mild to moderate side-effect that can be easily treated.
What can be done about nausea and vomiting?
Your doctor may give you anti-sickness medications during your treatment. These are also referred to as ‘anti-emetics’. There are several different anti- sickness medicines available.
If you are prescribed these medications, it is important to take them as directed by your doctor even if you do not feel sick at the time.
What you eat and drink can also relieve nausea and vomiting or may make it worse. Your oncology nurse or dietician can provide advice on eating to avoid nausea.
What should I do if I have nausea that does not go away?
If you have nausea that lasts for more than two days, or that keeps you from doing important and enjoyable things, tell your doctor or nurse. Your anti-sickness medication may need to be changed or the dose increased.
What should I know about reduced appetite
and weight loss?
It is common for people to lose weight during cancer treatment. This can be because cancer treatment reduces your appetite or it might be because of the cancer itself.
How common is weight loss with LENVIMA?
Around 1 in 3 people treated with LENVIMA for HCC will experience weight loss during treatment.
How can I improve my appetite?
Taste changes may make you lose your appetite. Improving the taste of food may help to stimulate your appetite.
If food is too sweet, add salt, lemon juice or coffee powder; if food tastes metallic or salty, add sugar or honey
Add spices, garlic, herbs, cheese or bacon to enhance flavour Use a straw to bypass your taste buds.
If you can eat but find that you feel full soon after eating a meal, it can help to eat small meals or snacks frequently, rather than large meals.
Having an empty stomach can cause you to feel nauseated, so make sure you snack regularly.

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What should I know about abdominal pain?
Some people experience abdominal pain during cancer treatment. Abdominal pain may occur because of the treatment or because of the cancer itself. Controlling pain may allow you to return to many of the activities you enjoy.
How common is abdominal pain with LENVIMA?
Nearly 1 in 5 people (17%) treated with LENVIMA for HCC will experience abdominal pain. This is mild and manageable for most people.
What can be done about abdominal pain?
Pain can be controlled by taking medication. Pain-killing drugs are known as analgesics and there are several different types that can treat different levels of pain. Mild pain can be treated with paracetamol or non-steroidal anti- inflammatory drugs. Moderate pain can be treated with mild opioids such
as codeine. Strong pain may be treated with stronger opioids.
Taking pain medication regularly can help you stay on top of the pain, and
it may mean you need lower doses than if you wait until the pain is bad before taking medication.
If your pain-killers are making you drowsy or causing other side-effects, talk to your doctor as your dosage might need to be adjusted.
Are there alternative methods to relieve pain?
Not everyone will need to take pain-killers to reduce their pain. For some people, movement such as walking and stretching might reduce pain.
A physiotherapist or exercise physiologist can design a program to help
get you moving. Relaxation techniques such as mindfulness and meditation, applying hot or cold packs, or relaxation massage might also help.
Talk to your doctor about what you are doing to reduce pain, as some complementary therapies may not be advisable with certain treatments.
What should I know about hand-foot syndrome?
Hand-foot syndrome is also known as palmar-plantar erythrodysaesthesia (PPE). It is a common side-effect of many cancer therapies, which affects the palms of your hands and/or soles of your feet.
The symptoms include: Red, inflamed skin Tenderness
Pain
Swelling
Tingling, pins and needles Numbness
Itchiness
Blisters
Dry rash
Weeping skin
Ulcers
Sensory impairment.
How common is hand-foot syndrome with LENVIMA?
Around 1 in 4 people treated with LENVIMA for HCC will develop hand-foot syndrome. Symptoms are mild to moderate for most people – only 5% of people who experienced hand-foot syndrome on LENVIMA needed a dose interruption or reduction.
What can be done about hand-foot syndrome?
Symptoms of hand-foot syndrome can be treated using topical creams on your wounds, cold compresses, moisturisers, topical drugs called corticosteroids, and pain-killers.

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What should I know about bleeding events?
Bleeding during cancer therapy occurs because the treatment decreases the number of platelets in your blood. Platelets are involved in blood clotting. When there aren’t enough platelets to cause clots, it may cause you to bleed.
How common is bleeding with LENVIMA?
Around 1 in 5 people taking LENVIMA for HCC will experience bleeding, with the majority of cases being mild or moderate and manageable.
Where does bleeding occur?
The most common place people on cancer treatment experience bleeding is through the nose. Bleeding may also happen at other sites, such as blood in the urine, bruising, bleeding from the gums or the gut wall.
How is bleeding treated?
Your doctor will monitor your platelet levels by taking a blood test. If your platelet levels get very low, you may need a platelet transfusion.
If you are going to have surgery, your doctor may stop LENVIMA for a short time before the procedure to reduce the risk of post-surgical bleeding.
What should I know about developing a hoarse voice?
Hoarseness of voice (dysphonia) is a side-effect of some cancer treatments. You may have a different sounding voice, strain to speak or in very rare cases completely lose your voice (approximately 1% of people).
How common is dysphonia with LENVIMA?
Around 1 in 4 people taking LENVIMA for HCC will experience hoarseness of their voice, and in most cases this is mild to moderate.
How can I manage changes to my voice?
If you are struggling to talk, it’s natural to feel distressed, frustrated or angry
at times. It may take time and practice to get your voice back and you might find that you need to repeat yourself if your voice is very hoarse. In many cases, the hoarseness may resolve on its own. You can use the National Relay Service to make phone calls.

LENVIMA treatment contacts
Use this page to record the names and phone numbers of your treatment centre and healthcare professionals.
Hospital department:
Liver specialist doctor: Specialist nurse:
After-hours emergency contact: General practitioner:
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NOTES
References 1. LENVIMA Consumer Medicine Information. Eisai Australia Pty Ltd. September 2018. 2. LENVIMA Product Information. Eisai Australia Pty Ltd. September 2018. 3. NSW Government and Cancer Institute NSW. EviQ. Cancer Treatments Online. Side effect fact sheets. Available at: https://www.eviq.org.au/patients-and-carers/ patient-information-sheets (Accessed September 2018). 4. Cancer Council South Australia. Physical side effects
after cancer. Available at: https://www.cancersa.org.au/information/a-z-index/physical-side-effects-after-cancer (Accessed September 2018). 5. NSW Government and Cancer Institute NSW. EviQ. Clinical Resources. Side effect and toxicity management. Available at: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management (Accessed September 2018). 6. Cancer Council Victoria. Managing side effects of chemotherapy. Available at: https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_ chemotherapy.html (Accessed September 2018). 7. Cancer Council Victoria. Managing side effects of head & neck cancer. Available at https://www.cancervic.org.au/cancer-information/cancer-types/cancer_types/head-neck- cancers/recovery-head-neck.html (Accessed September 2018).
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LENVIMA® is a registered trademark of Eisai Australia Pty Ltd PO Box 33004, Melbourne VIC 3004. ABN 73 117 970 993. Contact Eisai Australia Medical Information
on 03 9832 9100 or medinfo_australia@eisai.net.
Date of preparation: March 2019. AU-LENA-19-00019