Management of lenvatinib-induced proteinuria with dapagliflozin.

Proteinuria is an adverse event described in 30% of thyroid cancer patients treated with lenvatinib, a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptors. Management of proteinuria is challenging, involving control of arterial hypertension. We describe the case of a patient with advanced radioiodine refractory thyroid cancer treated with lenvatinib who developed late-onset grade 3 proteinuria, despite adequate blood pressure control. He was treated with dapagliflozin 10 mg/day, which promptly improved proteinuria to grade 1. Treatment with lenvatinib was subsequently restarted, with good control of proteinuria. Dapagliflozin is a sodiumglucose co-transporter type 2 (SGLT2) inhibitor that acts in the proximal convoluted tubule, improving renal function in diabetic and non-diabetic patients. SGLT2 inhibitors may have a role in the management of lenvatinib-induced proteinuria, however further study is needed.