PURPOSE: Lenvatinib is an oral multi-targeted tyrosine kinase inhibitor of 
VEGFR1-3, FGFR1-4, PDGFRβ, RET, and KIT. Everolimus is an oral mammalian target 
of rapamycin inhibitor approved for advanced renal cell carcinoma (RCC). This 
phase 1b study assessed safety, maximum tolerated dose (MTD), and preliminary 
antitumor activity of lenvatinib plus everolimus in metastatic RCC (mRCC) 
patients.
METHODS: Patients with advanced unresectable or mRCC and Eastern Cooperative 
Oncology Group performance status 0-1 were eligible (number of prior treatments 
not restricted). Starting dose was lenvatinib 12 mg once daily with everolimus 5 
mg once daily administered continuously in 28-day cycles using a conventional 3 
+ 3 dose-escalation design. At the MTD, additional patients were enrolled in an 
expansion cohort.
RESULTS: Twenty patients (mean 58.4 years) received lenvatinib [12 mg (n = 7); 
18 mg (n = 11); 24 mg (n = 2)] plus everolimus 5 mg. MTD was established as once 
daily lenvatinib 18 mg plus everolimus 5 mg. The most common treatment-related 
treatment-emergent adverse events (all dosing cohorts) were fatigue 60 % (Grade 
≥3: 10 %), mucosal inflammation 50 %, proteinuria (Grade ≥3: 15 %), diarrhea 
(Grade ≥3: 10 %), vomiting (Grade ≥3: 5 %), hypertension, and nausea, each 40 %. 
In MTD and lowest-dose cohorts (n = 18), best responses of partial response and 
stable disease were achieved in 6 (33 %) and 9 (50 %) patients, respectively.
CONCLUSIONS: Lenvatinib 18 mg combined with everolimus 5 mg was associated with 
manageable toxicity consistent with individual agents and no new safety signals. 
Observed activity warrants further evaluation of the combination in advanced RCC 
patients.