Opinion|Videos|July 15, 2026
Managing Adverse Events With Lenvatinib and Pembrolizumab in Thyroid Cancer
Lori Wirth, MD, discusses practical considerations for managing adverse events with the combination of lenvatinib and pembrolizumab in radioactive iodine–refractory differentiated thyroid cancer.
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Lori Wirth, MD, discusses practical considerations for managing adverse events with the combination of lenvatinib and pembrolizumab in radioactive iodine–refractory differentiated thyroid cancer. A key clinical challenge is distinguishing lenvatinib-associated diarrhea from immune-related colitis caused by pembrolizumab. Wirth explains that this differentiation is typically straightforward in practice, as holding lenvatinib often leads to rapid symptom improvement if the diarrhea is drug-related. If symptoms persist, further evaluation for immune-mediated toxicity is warranted. Overall, overlapping toxicities between the two agents are limited, allowing clinicians to manage adverse events according to established strategies for each therapy individually. Lenvatinib-related toxicities are addressed with dose holds and reductions, while immune-related adverse events from pembrolizumab are managed per standard immunotherapy guidelines. This approach supports safe and effective use of combination therapy in selected patients.
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