Efficacy and safety comparison between Lenvatinib and Sorafenib in hepatocellular carcinoma treatment: a systematic review and meta-analysis of real-world study

Disproportionality analysis of cardiac adverse events associated with lenvatinib using the Japanese Adverse Drug Event Report database

AIMS

This study was conducted to examine disproportionality, times to onset, incidence rates and outcomes of lenvatinib-associated cardiac adverse events (AEs) using the Japanese Adverse Drug Event Report database.

METHODS

We analysed data for the period between April 2004 and May 2023. Data on cardiac AEs were extracted and the relative disproportionality of AEs was estimated using reporting odds ratios (RORs). Furthermore, Weibull distribution parameters were calculated.

RESULTS

Of the 2 230 863 reports analysed, we identified 7684 reports of AEs associated with lenvatinib, including 317 cardiac AEs. Signals were detected for eight cardiac AEs: hypertension, cardiac failure, myocarditis, myocardial infarction, immune-mediated myocarditis, cardiomyopathy, angina unstable and cardiotoxicity. Among these, fatal outcomes were observed for cardiac failure, myocarditis and myocardial infarction. Histograms of median times to onset for the eight detected cardiac AE signals showed that AEs occurred at a median of 3.5-134.5 days after lenvatinib administration. The Weibull distributions showed that cardiac failure occurred early after administration (early failure type), myocarditis occurred in a dose-dependent manner (wearout failure type), and myocardial infarction occurred constantly throughout the exposure period (random failure type).

CONCLUSIONS

We focused on cardiac AEs associated with lenvatinib as post-marketing AEs. Serious outcomes can arise after lenvatinib administration. Patients should be monitored for signs of onset of these AEs not only at the start of administration, but also over an extended period.

Chloroquine and Chemotherapeutic Compounds in Experimental Cancer Treatment

Chloroquine (CQ) and its derivate hydroxychloroquine (HCQ), the compounds with recognized ability to suppress autophagy, have been tested in experimental works and in clinical trials as adjuvant therapy for the treatment of tumors of different origin to increase the efficacy of cytotoxic agents. Such a strategy can be effective in overcoming the resistance of cancer cells to standard chemotherapy or anti-angiogenic therapy. This review presents the results of the combined application of CQ/HCQ with conventional chemotherapy drugs (doxorubicin, paclitaxel, platinum-based compounds, gemcitabine, tyrosine kinases and PI3K/Akt/mTOR inhibitors, and other agents) for the treatment of different malignancies obtained in experiments on cultured cancer cells, animal xenografts models, and in a few clinical trials. The effects of such an approach on the viability of cancer cells or tumor growth, as well as autophagy-dependent and -independent molecular mechanisms underlying cellular responses of cancer cells to CQ/HCQ, are summarized. Although the majority of experimental in vitro and in vivo studies have shown that CQ/HCQ can effectively sensitize cancer cells to cytotoxic agents and increase the potential of chemotherapy, the results of clinical trials are often inconsistent. Nevertheless, the pharmacological suppression of autophagy remains a promising tool for increasing the efficacy of standard chemotherapy, and the development of more specific inhibitors is required.

Case Report: Lenvatinib for the treatment of recurrent hepatocellular carcinoma in people living with HIV: a report of two cases

The use and choice of the best systemic treatment is gaining increasing interest in people living with HIV (PLWH) because hepatocellular carcinoma (HCC) represents an increasing cause of morbidity and mortality in this setting and most HCCs are diagnosed in the advanced stage. Ten years ago, the multi-kinase inhibitor lenvatinib was approved in the first-line setting. However, to date, no data on the efficacy and tolerability of lenvatinib in PLWH from clinical trials and real-life studies are available. Case 1 was a gentleman with hepatitis B virus-related cirrhosis who underwent orthotopic liver transplantation for HCC and developed peritoneal metastasis several years later. Lenvatinib treatment was selected at HCC recurrence. This participant maintained undetectable HIV viremia and a relatively preserved immune status during 6 months of systemic treatment with lenvatinib. After 6 months, he discontinued lenvatinib for progression of the disease (growing of peritoneal metastasis) and uncontrolled hypertension. Case 2 was a gentleman with hepatitis C-genotype 1a-related cirrhosis who experienced unresectable recurrences after radiofrequency thermal ablation of the tumor. At the first recurrence, HCC was treated with six cycles of trans-catheter arterial chemoembolization; at the second recurrence, the participant underwent trans-catheter arterial radioembolization; and at the third recurrence, he received lenvatinib. A week after the start of lenvatinib, the participant had liver decompensation and discontinued therapy. The presently reported cases showed low tolerability of systemic therapy with lenvatinib in PLWH. Cumulative data are necessary to define the position of lenvatinib in this setting.