• Kinnosuke Matsumoto, Takayuki Shiroyama, Kotaro Miyake, Yuji Yamamoto, Tomoki Kuge, Midori Yoneda, Makoto Yamamoto, Yujiro Naito, Yasuhiko Suga, Kiyoharu Fukushima, Shohei Koyama, Kota Iwahori, Haruhiko Hirata, Izumi Nagatomo, Yoshito Takeda, and Atsushi Kumanogoh.
• Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Yamadaoka, Suita City, Osaka, Japan.
• Medicine (Baltimore). 2022 Jan 7; 101 (1): e28476.

RationaleThymic carcinoma (TC) is a malignant mediastinal tumor, and there are no established treatments for pre-treated patients with advanced TC. Recently, lenvatinib was approved for such patients in Japan, ahead of other countries. Higher dose lenvatinib may be more efficacious than conventional treatments, although many patients experience grade 3 hypertension. Therefore, lenvatinib dose reduction remains controversial in terms of efficacy and tolerability.Patient ConcernsCase 1 involves a 72-year-old woman who underwent complete resection of TC and was taking cilnidipine and azilsartan for hypertension. Six years later, multiple lung metastases were observed, and lenvatinib was started. Case 2 involves a 60-year-old man with TC, and was taking amlodipine for hypertension. A chest computed tomography showed progression in primary and metastatic lesions, and the patient started lenvatinib.DiagnosesIn both patients, grade 3 hypertension was observed after the administration of lenvatinib.InterventionsIn Case 1, lenvatinib dose was reduced 3 times because lenvatinib was not interrupted despite grade 3 hypertension. In contrast, in Case 2, lenvatinib was interrupted when grade 3 hypertension occurred and was resumed after a decrease in blood pressure to baseline.OutcomesIn Case 2, higher tumor regression may have been achieved because of the maintenance of a high dose of lenvatinib compared with that in Case 1.LessonsLenvatinib is a promising agent for advanced TC; however, hypertension should be addressed cautiously, especially at the outset of administration. Lenvatinib may have to be appropriately interrupted and resumed as soon as the blood pressure is controlled to maximize efficacy and minimize toxicity.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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