Real-world Analysis of Urinary Protein-to-Creatinine Ratio and Blood Pressure in Lenvatinib Therapy
Lenvatinib is widely used to treat several malignancies. Proteinuria is a frequent adverse event associated with lenvatinib; however, limited evidence exists regarding risk factors for severe proteinuria-specifically, a urine protein-to-creatinine ratio (UPCR) ≥3.5 g/g creatinine (g/gCre)-across multiple cancer types. This study aimed to identify risk factors for UPCR ≥3.5 g/gCre in patients with thyroid cancer, hepatocellular carcinoma, and endometrial cancer treated with lenvatinib. This retrospective study examined the incidence and risk factors for UPCR ≥3.5 g/gCre in patients treated with lenvatinib between January 2018 and December 2022. Of 195 patients screened, 131 met the inclusion criteria (thyroid cancer: 55; hepatocellular carcinoma: 55; endometrial cancer: 21). Ethics approval was obtained from the institutional review board. UPCR ≥3.5 g/gCre occurred in 34 patients (26.0%), with the highest rate in patients with thyroid cancer (45.5%). Univariate Cox proportional hazards analysis identified an initial lenvatinib dose of ≥20 mg/day [hazard ratio (HR)=2.54; 95% confidence interval (CI)=1.10-5.89; These findings emphasize the need for intensive blood pressure management and regular UPCR monitoring during lenvatinib therapy to reduce the risk of severe proteinuria, regardless of cancer type.