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Review Article
The role of lenvatinib in the era of immunotherapy of hepatocellular carcinoma
Matthew Man Pok Lee, Landon Long Chan, Stephen Lam Chan
J Liver Cancer. 2023;23(2):262-271.   Published online August 17, 2023
DOI: https://doi.org/10.17998/jlc.2023.07.17
  • 5,478 Views
  • 352 Downloads
  • 14 Citations
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) frequently presents as advanced stage with poor prognosis and high mortality. Systemic treatment is the treatment of choice for advanced disease. In 2007, the first multi-kinase inhibitor (MKI) sorafenib was approved and shown to modestly prolong overall survival (OS). The progress of systemic therapy has been slow afterwards until 2018 when lenvatinib, another MKI, was shown to be non-inferior to sorafenib on median OS as the first-line therapy for HCC. Since then, remarkable progress has been achieved on the treatment of advanced HCC, including the development of second-line targeted treatment, including regorafenib, cabozantinib and ramucirumab from 2017 to 2019. A growing focus has been placed on immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1), its ligand PD-L1, and cytotoxic T-lymphocyte-associated protein 4. These ICIs have proven their potency in treating HCC as both initial and subsequent line of therapy. At present, both regimens of atezolizumab combined with bevacizumab, as well as the combination of tremelimumab and durvalumab, are recommended as the first-line treatments based on positive phase III clinical trials. With the advancement of ICIs, it is anticipated that the role of MKIs in the treatment of HCC will evolve. In this article, lenvatinib, one of the most commonly used MKIs in HCC, is chosen to be reviewed.

Citations

Citations to this article as recorded by  
  • Bidirectional regulation of the cyclic guanosine monophosphate-adenosine monophosphate synthase-stimulator of interferon gene pathway and its impact on hepatocellular carcinoma
    Ai-Yu Nie, Zhong-Hui Xiao, Jia-Li Deng, Na Li, Li-Yuan Hao, Sheng-Hao Li, Xiao-Yu Hu
    World Journal of Gastrointestinal Oncology.2025;[Epub]     CrossRef
  • The anti-PD-L1/CTLA-4 bispecific antibody KN046 plus lenvatinib in advanced unresectable or metastatic hepatocellular carcinoma: a phase II trial
    Da Xu, Hongwei Wang, Quan Bao, Kemin Jin, Ming Liu, Wei Liu, Xiaoluan Yan, Lijun Wang, Yanqiao Zhang, Guangyu Wang, Yue Ma, Zhigang Ma, Chunhui Zhang, Jiebing Tang, Sha Wang, Jiaohui Pang, Ting Xu, Kun Wang, Baocai Xing
    Nature Communications.2025;[Epub]     CrossRef
  • Reduced-Dose or Discontinuation of Bevacizumab Might Be Considered after Variceal Bleeding in Patients with Hepatocellular Carcinoma Receiving Atezolizumab/Bevacizumab: Case Reports
    Kyeong-Min Yeom, Young-Gi Song, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
    Medicina.2024; 60(1): 157.     CrossRef
  • The Position of Multikinase Inhibitors in the Era of Immune-Checkpoint Inhibitors for Hepatocellular Carcinoma
    Beom Kyung Kim
    Gut and Liver.2024; 18(1): 3.     CrossRef
  • Fatal intratumoral hemorrhage in a patient with hepatocellular carcinoma following successful treatment with atezolizumab/bevacizumab: A case report
    Kyeong-Hoon Park, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
    World Journal of Clinical Cases.2024; 12(22): 5177.     CrossRef
  • Small molecule tyrosine kinase inhibitors approved for systemic therapy of advanced hepatocellular carcinoma: recent advances and future perspectives
    Jianzhong Liu, Shuai Xia, Baoyi Zhang, Dina Mostafa Mohammed, Xiangliang Yang, Yanhong Zhu, Xinnong Jiang
    Discover Oncology.2024;[Epub]     CrossRef
  • Consistent efficacy of hepatic artery infusion chemotherapy irrespective of PD‑L1 positivity in unresectable hepatocellular carcinoma
    Ji Kim, Young Kim, Hee-Chul Nam, Chang-Wook Kim, Jae-Sung Yoo, Ji Han, Jeong Jang, Jong Choi, Seung Yoon, Ho Jong Chun, Jung Oh, Suho Kim, Sung Lee, Pil Sung
    Oncology Letters.2024;[Epub]     CrossRef
  • The Role of the MiR-181 Family in Hepatocellular Carcinoma
    Jinbiao Chen, Ken Liu, Mathew A. Vadas, Jennifer R. Gamble, Geoffrey W. McCaughan
    Cells.2024; 13(15): 1289.     CrossRef
  • Role of transarterial chemoembolization for hepatocellular carcinoma with extrahepatic metastases in the era of advancing systemic therapy
    Byeong Geun Song, Myung Ji Goh, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Moon Seok Choi
    Journal of Liver Cancer.2024; 24(2): 243.     CrossRef
  • Dual effects of targeting neuropilin-1 in lenvatinib-resistant hepatocellular carcinoma: inhibition of tumor growth and angiogenesis
    Junjie Ao, Na Qiang, Hiroaki Kanzaki, Masato Nakamura, Risa Kakiuchi, Jiaqi Zhang, Ryuta Kojima, Keisuke Koroki, Masanori Inoue, Naoya Kanogawa, Ryo Nakagawa, Takayuki Kondo, Sadahisa Ogasawara, Shingo Nakamoto, Ryosuke Muroyama, Jun Kato, Naoya Kato
    American Journal of Physiology-Cell Physiology.2024; 327(4): C1150.     CrossRef
  • A Potential Pneumothorax Induced by Immune Checkpoint Inhibitors: A Case Report and Literature Review
    Yoon-E Shin, Hyuk Kim, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
    Medicina.2024; 60(10): 1634.     CrossRef
  • Challenges and advances of immune checkpoint therapy
    Lingyu Li, Yingli Sun
    Clinical and Translational Discovery.2024;[Epub]     CrossRef
  • Current perspectives on the pharmacological treatment of advanced hepatocellular carcinoma: a narrative review
    Hye-Jin Yoo, Jeong-Ju Yoo, Sang Gyune Kim, Young Seok Kim
    The Ewha Medical Journal.2024;[Epub]     CrossRef
  • Vascular Endothelial Growth Factor (VEGF) Family and the Immune System: Activators or Inhibitors?
    Cristina Maria Failla, Maria Luigia Carbone, Carmela Ramondino, Emanuele Bruni, Angela Orecchia
    Biomedicines.2024; 13(1): 6.     CrossRef
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Case Report
A case report of a patient presented with skin ulcer after treatment of lenvatinib
Serin Cha, Dong Woo Kim, Jung Wan Choe, Tae Hyung Kim, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Young Kul Jung, Hyung Joon Yim
J Liver Cancer. 2021;21(2):194-198.   Published online September 30, 2021
DOI: https://doi.org/10.17998/jlc.2021.09.20
  • 4,648 Views
  • 101 Downloads
  • 3 Citations
AbstractAbstract PDF
A 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC) presented to the hospital with pain in the perineal region. He had been taking lenvatinib every day for 2 months after he was diagnosed with HCC with metastases to the lymph node, small bowel mesentery, and retroperitoneal space. Enhanced abdominal computed tomography revealed mild elevation in intensity in the perineal subcutaneous tissue with subcutaneous emphysema. The patient was diagnosed with Common Terminology Criteria for Adverse Events grade 3, skin ulceration of stage IV with full-thickness skin loss and tissue necrosis in the muscular layer. The patient was taken off the medication with prescription of antibiotics, and after 3 weeks, the skin has fully recovered. This is the first report of an HCC patient who presented with a skin ulceration of stage IV after lenvatinib treatment. We recommend stopping the medication immediately and changing to alternative treatments with appropriate supportive care.

Citations

Citations to this article as recorded by  
  • Roles of clinical application of lenvatinib and its resistance mechanism in advanced hepatocellular carcinoma (Review)
    Ganghui Ye
    American Journal of Cancer Research.2024; 14(9): 4113.     CrossRef
  • Multiple lenvatinib‐associated skin ulcers: A case report and literature review
    Soo Hyun Jeon, Woo Jin Lee, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee, Joon Min Jung
    Australasian Journal of Dermatology.2023;[Epub]     CrossRef
  • Tyrosine Kinase Inhibitors Induced Scrotal Ulcerations
    Abhipsa Samal, Nibedita Dixit, Bikash R. Kar, Liza Mohapatra
    Indian Journal of Dermatology.2023; 68(2): 235.     CrossRef
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Original Article
Infiltration of T Cells and Programmed Cell Death Ligand 1-expressing Macrophages as a Potential Predictor of Lenvatinib Response in Hepatocellular Carcinoma
Pil Soo Sung, Sung Woo Cho, Jaejun Lee, Hyun Yang, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon
J Liver Cancer. 2020;20(2):128-134.   Published online September 30, 2020
DOI: https://doi.org/10.17998/jlc.20.2.128
  • 4,353 Views
  • 106 Downloads
  • 8 Citations
AbstractAbstract PDF
Background/Aims
Lenvatinib was recently proven to be non-inferior to sorafenib in treating unresectable hepatocellular carcinoma (HCC) in a phase-3 randomized controlled trial. In this study, we investigated whether the response to lenvatinib was affected by tumor immunogenicity.
Methods
Between May 2019 and April 2020, nine patients with intermediate-to-advanced HCC, who were treated with lenvatinib after liver biopsy, were enrolled. Immunohistochemical staining and multi-color flow cytometry were performed on specimens obtained from liver biopsy.
Results
Among the nine patients enrolled, four showed objective responses (complete responses+partial responses). Immunohistochemical staining for CD3, CD68, and programmed cell death ligand 1 (PD-L1) demonstrated that patients with objective responses showed marked infiltration of T cells and PD-L1-expressing macrophages in intra-tumoral and peri-tumoral tissues compared to those without objective responses. A significant difference in the numbers of infiltrated T cells, both in the intra-tumoral (P<0.01) and peri-tumoral regions (P<0.05), were identified between responders and non-responders. Regarding the number of infiltrated macrophages, no significant difference was found between the responders and non-responders, although the number of PD-L1-expressing tumor-associated macrophages was significantly higher in responders than that in non-responders (P<0.05).
Conclusions
Tumor immunogenicity, as indicated by T cell and PD-L1-positive macrophage infiltration, affects lenvatinib response in unresectable HCC.

Citations

Citations to this article as recorded by  
  • Roles of clinical application of lenvatinib and its resistance mechanism in advanced hepatocellular carcinoma (Review)
    Ganghui Ye
    American Journal of Cancer Research.2024; 14(9): 4113.     CrossRef
  • Recent Advances in Immune-based Therapy for Hepatocellular Carcinoma
    Kyung Won Park, Tae Hoon Park, Eun Ji Jang, Pil Soo Sung
    Journal of Digestive Cancer Research.2024; 12(2): 115.     CrossRef
  • Higher Number of Tumor-Infiltrating PD-L1+ Cells Is Related to Better Response to Multikinase Inhibitors in Hepatocellular Carcinoma
    Ji Won Han, Ji Hoon Kim, Dong Hyun Kim, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Jaegyoon Ahn, Hyun Yang, Pil Soo Sung
    Diagnostics.2023; 13(8): 1453.     CrossRef
  • Intrahepatic inflammatory IgA+PD-L1high monocytes in hepatocellular carcinoma development and immunotherapy
    Pil Soo Sung, Dong Jun Park, Pu Reun Roh, Kyoung Do Mun, Sung Woo Cho, Gil Won Lee, Eun Sun Jung, Sung Hak Lee, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Jonghwan Choi, Jaegyoon Ahn, Seung Kew Yoon
    Journal for ImmunoTherapy of Cancer.2022; 10(5): e003618.     CrossRef
  • Crosstalk between tumor-associated macrophages and neighboring cells in hepatocellular carcinoma
    Pil Soo Sung
    Clinical and Molecular Hepatology.2022; 28(3): 333.     CrossRef
  • Blood-based biomarkers for immune-based therapy in advanced HCC: Promising but a long way to go
    Pil Soo Sung, Isaac Kise Lee, Pu Reun Roh, Min Woo Kang, Jaegyoon Ahn, Seung Kew Yoon
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Immunological Mechanisms for Hepatocellular Carcinoma Risk after Direct-Acting Antiviral Treatment of Hepatitis C Virus Infection
    Pil Soo Sung, Eui-Cheol Shin
    Journal of Clinical Medicine.2021; 10(2): 221.     CrossRef
  • Preferential Expression of Programmed Death Ligand 1 Protein in Tumor-Associated Macrophages and Its Potential Role in Immunotherapy for Hepatocellular Carcinoma
    Dong-Jun Park, Pil-Soo Sung, Gil-Won Lee, Sung-Woo Cho, Sung-Min Kim, Byung-Yoon Kang, Won-Hee Hur, Hyun Yang, Soon-Kyu Lee, Sung-Hak Lee, Eun-Sun Jung, Chang-Ho Seo, Joseph Ahn, Ho-Joong Choi, Young-Kyoung You, Jeong-Won Jang, Si-Hyun Bae, Jong-Young Cho
    International Journal of Molecular Sciences.2021; 22(9): 4710.     CrossRef
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