Abstract: FR-PO1264
Successful Management of Lenvatinib-Induced Proteinuria and Hypertension with an Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Finerenone: A Case Report
Session Information
- Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1600 Onconephrology
Author
- Liu, Fanna, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
Introduction
Lenvatinib, a multi-targeted TKI with potent anti-VEGF activity, commonly causes hypertension and proteinuria via podocyte injury and thrombotic microangiopathy. Nephrotic-range proteinuria often necessitates drug discontinuation, compromising oncological outcomes. We report a case where adding finerenone to sacubitril/valsartan achieved significant proteinuria reduction, with an inadvertent withdrawal-rechallenge confirming its therapeutic effect.
Case Description
A 53-year-old female with advanced ovarian cancer on lenvatinib 8 mg daily presented with one-month progressive edema, foamy urine, and hypertension (188/76 mmHg). She had prior thyroidectomy for thyroid cancer and sequential TKI use (sorafenib, anlotinib) before lenvatinib, with no history of hypertension or diabetes. Examination revealed significant edema. Labs: creatinine 102 µmol/L, eGFR 92 mL/min/1.73m2, albumin 32.3 g/L, 24-h urine protein 3.6 g/day, ACR 3,800 mg/g. Serological workup (anti-PLA2R, ANCA, ANA, complements), renal ultrasound, and fundoscopy were unremarkable. A clinical diagnosis of lenvatinib-induced nephropathy was made; discontinuing lenvatinib was oncologically infeasible.
Sacubitril/valsartan 200 mg bid and furosemide were started. After two weeks, proteinuria persisted at 3.4 g/day despite improved blood pressure. Adding finerenone 20 mg qd reduced proteinuria to 0.9 g/day within one month, with stable renal function and potassium. The patient later self-discontinued finerenone; one year later, ACR rebounded to 1,647 mg/g. Reintroducing finerenone reduced ACR to 300 mg/g over six months, demonstrating its independent anti-proteinuric effect.
Discussion
In lenvatinib-induced nephrotic-range proteinuria where drug cessation is not an option, dual blockade with sacubitril/valsartan and finerenone achieved sustained proteinuria reduction, enabling continued oncological therapy. The withdrawal-rechallenge observation provides compelling evidence for finerenone's role in this setting and warrants further investigation in onconephrology.