Anlotinib is an anti-tumor targeted drug. Its common adverse reactions include hypertension, bleeding risk, hand-foot syndrome, proteinuria, and gastrointestinal reactions. Medication must be administered strictly in accordance with the doctor's instructions, and relevant indicators should be monitored regularly.
Major Adverse Reactions and Management
1. Hypertension
It has a relatively high incidence rate (approximately 56.2%), mostly persistent, and may occur within 2 weeks after medication initiation. Blood pressure must be monitored daily during the initial stage of treatment, and 2–3 times per week thereafter. Grade 3/4 hypertension (systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg) requires temporary suspension of medication; dosage adjustment should be made after blood pressure returns to normal. In case of hypertensive crisis, medication must be discontinued immediately and medical attention should be sought.
2. Bleeding Risk
Manifestations include hemoptysis, gastrointestinal bleeding, epistaxis, etc., which can be life-threatening in severe cases. Grade 2 bleeding (e.g., persistent mild bleeding) requires temporary drug suspension and symptomatic treatment; dosage adjustment can be performed after recovery. Grade ≥ 3 bleeding (e.g., massive hemoptysis, cerebral hemorrhage) necessitates permanent drug discontinuation and emergency intervention. Anlotinib is contraindicated in patients with central-type lung squamous cell carcinoma or those at risk of massive hemoptysis.
3. Hand-Foot Syndrome
The incidence rate is approximately 41.6%, characterized by redness, desquamation, and pain of the skin on hands and feet. It is necessary to keep the skin clean, avoid friction, and apply moisturizers or corticosteroid ointments locally. For grade ≥ 3 hand-foot syndrome, dosage adjustment or drug discontinuation is required.
4. Proteinuria
Approximately 34.9% of patients develop proteinuria, and regular urinalysis is required. If urine protein is ≥ ++ for two consecutive tests, further evaluation is needed; dosage adjustment or drug withdrawal should be implemented in severe cases. Anlotinib should be used with caution in patients with renal insufficiency.
5. Gastrointestinal Reactions
Common symptoms include diarrhea (34.3%), abdominal pain (27.0%), nausea, and vomiting. Mild symptoms can be managed symptomatically (e.g., with antidiarrheals, fluid replacement). Severe diarrhea requires temporary drug suspension and exclusion of other etiologies.
6. Other Common Adverse Reactions
Thyroid dysfunction: Approximately 21.3% of patients develop hypothyroidism, and regular monitoring of thyroid hormone levels is required.
Hyperlipidemia: Hypertriglyceridemia occurs in approximately 35.9% of cases; dietary adjustments should be made, and lipid-lowering drugs can be administered when necessary.
QT interval prolongation: This may induce arrhythmia, so regular electrocardiogram monitoring is required. Anlotinib should be used with caution in patients with underlying heart diseases.
Precautions for Special Populations
Patients with hepatic and renal insufficiency: Use with caution in patients with mild to moderate insufficiency; contraindicated in severe cases.
Pregnant and lactating women: Contraindicated. Strict contraception must be adopted during medication.
Elderly patients: No dosage adjustment is required for patients aged over 65 years, but close monitoring of adverse reactions is necessary.
Principles of Dosage Adjustment
Depending on the severity of adverse reactions, temporary drug suspension, dosage reduction (e.g., from 12 mg to 10 mg or 8 mg), or permanent discontinuation may be required.
Concurrent use with CYP1A2/CYP3A4 inhibitors (e.g., ciprofloxacin) or inducers (e.g., rifampicin) should be avoided to prevent interference with plasma drug concentration.
If severe discomfort occurs during medication (e.g., chest pain, dyspnea, confusion), immediate medical attention is required. All treatment adjustments must be performed under the guidance of a physician.
