Comparative Pharmacology
Head-to-head clinical analysis: LENVATINIB versus MIDOSTAURIN.
Peer-Reviewed Evidence
Head-to-head clinical analysis: LENVATINIB versus MIDOSTAURIN.
LENVATINIB vs MIDOSTAURIN
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Lenvatinib is a kinase inhibitor that inhibits the receptor tyrosine kinases (RTKs) including VEGFR1 (FLT1), VEGFR2 (KDR), VEGFR3 (FLT4), FGFR1, FGFR2, FGFR3, FGFR4, PDGFRα, KIT, and RET. It also inhibits the kinase activities of other RTKs involved in tumor angiogenesis and tumor growth.
Midostaurin is a multikinase inhibitor that targets FLT3 (FMS-like tyrosine kinase 3), KIT, PDGFRα/β, VEGFR2, and PKC. It inhibits FLT3 receptor signaling and downstream MAPK/ERK and PI3K/AKT pathways, inducing apoptosis in FLT3-mutated cells.
24 mg orally once daily for differentiated thyroid carcinoma; 8 mg twice daily or 12 mg once daily in combination with everolimus for renal cell carcinoma; 12 mg once daily in combination with pembrolizumab for advanced endometrial carcinoma.
50 mg orally twice daily with food for acute myeloid leukemia (AML) with FLT3 mutation; for advanced systemic mastocytosis, 100 mg orally twice daily.
None Documented
None Documented
Clinical Note
moderateMidostaurin + Digoxin
"Midostaurin may decrease the cardiotoxic activities of Digoxin."
Clinical Note
moderateLenvatinib + Digoxin
"Lenvatinib may decrease the cardiotoxic activities of Digoxin."
Clinical Note
moderateMidostaurin + Digitoxin
"Midostaurin may decrease the cardiotoxic activities of Digitoxin."
Clinical Note
moderateLenvatinib + Digitoxin
"Lenvatinib may decrease the cardiotoxic activities of Digitoxin."
Approximately 28 hours (range 22-35 hours); supports once-daily dosing with steady-state achieved in ~5-7 days.
The terminal elimination half-life (t½) of midostaurin is approximately 20 hours (range 17–22 h) for the parent drug and slightly longer for its active metabolite CGP52421 (~30 h). This supports twice-daily dosing while maintaining steady-state concentrations.
Fecal (approximately 64% of dose) and renal (approximately 25% of dose, with <2% as unchanged drug).
Midostaurin is primarily eliminated via feces (approximately 95% of total radioactivity after a single 50 mg oral dose), with <5% excreted in urine. Biliary excretion is the major route for fecal elimination; unchanged midostaurin accounts for <10% of the dose, with the remainder as metabolites.
Category C
Category C
Tyrosine Kinase Inhibitor
Tyrosine Kinase Inhibitor