Key result
High-normal baseline blood pressure was associated with a higher risk of developing lenvatinib-induced grade ≥3 hypertension compared to optimal baseline blood pressure (OR 7.48; 95% CI 1.67-33.51).
Why the study?
Hypertension is the most common adverse event of lenvatinib, but blood pressure trends after initiation and outcomes with antihypertensive treatment remain unclear.
Does higher baseline blood pressure increase the risk of lenvatinib-induced hypertension grade ≥3 in patients with thyroid cancer?
Cohort (n=65)
Does higher baseline blood pressure increase the risk of lenvatinib-induced hypertension grade ≥3 in patients with thyroid cancer?
Odds Ratio: 7.48 (95% CI 1.67–33.51)
Higher baseline blood pressure, even within the non-hypertensive range, is a significant risk factor for developing grade ≥3 hypertension early after lenvatinib initiation in thyroid cancer patients.
Higher baseline BP signals early grade ≥3 hypertension risk with lenvatinib; observational data leave optimal management strategies open.
BACKGROUND: Hypertension is the most frequently occurring adverse event of lenvatinib, recognized relatively early in its course. However, the trend in blood pressure after the initiation of lenvatinib and the outcomes with antihypertensive treatment are unclear. This study aimed to clarify the association between baseline blood pressure and the incidence of lenvatinib-induced hypertension in patients with thyroid cancer. METHODS: This retrospective study included 65 patients without hypertension at the time of lenvatinib initiation. Patients were divided into two groups: those who developed hypertension grade ≥3 (HTN group) and those who did not develop hypertension grade ≥3 (non-HTN group). RESULTS: Of the 65 patients, 46 (71%) developed hypertension grade ≥3. In both HTN and non-HTN groups, blood pressure significantly increased the day after lenvatinib initiation. There was no significant difference in the elevated values of both the changes in systolic blood pressure (ΔSBP) and diastolic blood pressure (ΔDBP) between the two groups, with an average increase of 20 mmHg in SBP and 13 mmHg in DBP from baseline. The median (range) time to the onset of hypertension grade ≥3 was 2 days (1-12 days). In the multivariable analysis, patients with normal (SBP 120-129 mmHg and/or DBP 80-84 mmHg) or high-normal baseline blood pressure (SBP 130-139 mmHg and/or DBP 85-89 mmHg) were at higher risk of developing hypertension grade ≥3 than those with optimal baseline blood pressure (SBP <120 mmHg and DBP <80 mmHg) (odds ratio [OR], 5.07; 95% confidential interval [CI] 1.09-23.54 and OR, 7.48; 95% CI, 1.67-33.51, respectively). CONCLUSIONS: Lenvatinib-induced hypertension appears the day after administration, and higher baseline blood pressure is a significant risk factor for developing hypertension grade ≥3. In cases of increased blood pressure with lenvatinib, early initiation of antihypertensives may prevent treatment interruption due to hypertension and maintain the therapeutic intensity of lenvatinib.
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Shibutani et al. (2023) conducted a cohort in Thyroid cancer (n=65). Normal or high-normal baseline blood pressure vs. Optimal baseline blood pressure (SBP <120 mmHg and DBP <80 mmHg) was evaluated on Development of hypertension grade ≥3 (OR 7.48, 95% CI 1.67-33.51). High-normal baseline blood pressure was associated with a higher risk of developing lenvatinib-induced grade ≥3 hypertension compared to optimal baseline blood pressure (OR 7.48; 95% CI 1.67-33.51).
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