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Porta C, Negri F, Cosmai L. Hepatocellular carcinoma, vascular endothelial growth factor receptors-targeting agents, and hypertension: A much more complicated relationship than expected. Cancer 2024; 130:1208-1209. [PMID: 38280211 DOI: 10.1002/cncr.35218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Hepatocellular carcinoma (HCC) relationship with hypertension is a complicated phenomenon, mainly depending on the causes of the primary liver disease and the potential for drug interactions between concomitant medications and vascular endothelial growth factor receptor inhibitors. Another interesting point worth exploring is how to treat hypertension in HCC patients under anticancer multikinase inhibitor therapy and the possible impact of certain antihypertensive agents on patients’ outcome.
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Affiliation(s)
- Camillo Porta
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Francesca Negri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Laura Cosmai
- Onconephrology Outpatient Clinic, Division of Nephrology and Dialysis, ASST Fatebenefratelli-Sacco, Milan, Italy
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Simao P, Almeida MJ, Catela J, Matias F. Convexal subarachnoid haemorrhage in a patient under pembrolizumab-lenvatinib combination therapy. BMJ Case Rep 2023; 16:e256100. [PMID: 38081747 PMCID: PMC10728919 DOI: 10.1136/bcr-2023-256100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
A woman in her 60s was brought to the emergency department due to a new-onset seizure. She was drowsy on arrival and unable to provide a clinical history. She had a medical history of advanced endometrial cancer, for which she was under the therapeutic protocol pembrolizumab plus lenvatinib. Laboratorial investigations were unremarkable. The brain CT angiography provided further insight into the case by detecting a bilateral convexal subarachnoid haemorrhage with discrete bilateral opercular vasogenic oedema, without other noticeable structural changes. Cerebrospinal fluid analysis was macroscopically haemorrhagic, but otherwise unremarkable. The brain MRI did not provide additional information. Although considered a rare adverse reaction, cerebral haemorrhage has been described for both pembrolizumab and lenvatinib. We cautiously assumed a probable drug aetiology after a thorough review of potential causes. Following discontinuation of these drugs and under anti-convulsive therapy, the patient remained asymptomatic and was discharged home.
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Affiliation(s)
- Paulo Simao
- Internal Medicine, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal
- Internal Medicine, Centro Hospitalar e Universitário Cova da Beira EPE, Covilhã, Portugal
| | - Marco José Almeida
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - João Catela
- Neurosurgery, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Fernando Matias
- Neurology, Centro Hospitalar e Universitario de Coimbra EPE Campus dos Hospitais da Universidade de Coimbra, Coimbra, Portugal
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Long J, Liu L, Yang X, Lu X, Qin L. Impact of combining Lenvatinib with Transarterial chemoembolization for unresectable hepatocellular carcinoma. Pak J Med Sci 2023; 39:1847-1852. [PMID: 37936761 PMCID: PMC10626123 DOI: 10.12669/pjms.39.6.7944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/01/2023] [Accepted: 08/08/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives To investigate the impact of combining lenvatinib with transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC). Methods This was a retrospective observational study which reviewed the medical records of 103 unresectable HCC patients from January 2017 to June 2020 in The First Affiliated Hospital of Soochow University. It included 46 patients who received TACE plus lenvatinib and 57 patients who received TACE alone. The levels of serum indicators, clinical effect, adverse events, overall survival (OS), and progression-free survival (PFS) were compared between the two groups. Results AFP and VEGF levels in the TACE+lenvatinib group post-treatment were significantly lower than the TACE group (P<0.05). The clinical efficacy in the TACE+lenvatinib group (69.57%) was higher than that in the TACE group (40.35%) post-treatment (P<0.05). There were significant differences in hypertension, diarrhea, and bleeding (gingiva) between the two groups (P<0.05). There were no significant differences in one or two year PFS rate or one year OS between groups (P>0.05), while the two years survival rate in the TACE+lenvatinib group was significantly higher than that in the TACE group (P<0.05). Conclusions TACE combined with lenvatinib have a high clinical effective rate, with reduced AFP and VEGF levels, higher two year survival rate, and acceptable incidence of adverse events.
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Affiliation(s)
- Jianwu Long
- Jianwu Long, Department of General Surgery, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu province, P.R. China
| | - Longfei Liu
- Longfei Liu, Department of Hepatobiliary Surgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan province, P.R. China
| | - Xuefeng Yang
- Xuefeng Yang, Department of Hepatobiliary Surgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan province, P.R. China
| | - Xianzhou Lu
- Xianzhou Lu Department of General Surgery, Hengyang County People’s Hospital, Hengyang, Hunan province, P.R. China
| | - Lei Qin
- Lei Qin, Department of General Surgery, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu province, P.R. China
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Capdevila J, Deandreis D, Durante C, Leboulleux S, Luster M, Netea-Maier R, Newbold K, Singer S, Sykiotis GP, Bartes B, Farnell K, Locati LD. Use of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer: a multidisciplinary perspective for daily practice. Eur Thyroid J 2023; 12:e230068. [PMID: 37429326 PMCID: PMC10448584 DOI: 10.1530/etj-23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/10/2023] [Indexed: 07/12/2023] Open
Abstract
Background Most thyroid cancers of follicular origin have a favorable outcome. Only a small percentage of patients will develop metastatic disease, some of which will become radioiodine refractory (RAI-R). Important challenges to ensure the best therapeutic outcomes include proper, timely, and appropriate diagnosis; decisions on local, systemic treatments; management of side effects of therapies; and a good relationship between the specialist, patients, and caregivers. Methods With the aim of providing suggestions that can be useful in everyday practice, a multidisciplinary group of experts organized the following document, based on their shared clinical experience with patients with RAI-R differentiated thyroid cancer (DTC) undergoing treatment with lenvatinib. The main areas covered are patient selection, initiation of therapy, follow-up, and management of adverse events. Conclusions It is essential to provide guidance for the management of RAI-R DTC patients with systemic therapies, and especially lenvatinib, since compliance and adherence to treatment are fundamental to achieve the best outcomes. While the therapeutic landscape in RAI-R DTC is evolving, with new targeted therapies, immunotherapy, etc., lenvatinib is expected to remain a first-line treatment and mainstay of therapy for several years in the vast majority of patients and settings. The guidance herein covers baseline work-up and initiation of systemic therapy, relevance of symptoms, multidisciplinary assessment, and patient education. Practical information based on expert experience is also given for the starting dose of lenvatinib, follow-up and monitoring, as well as the management of adverse events and discontinuation and reinitiating of therapy. The importance of patient engagement is also stressed.
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Affiliation(s)
- Jaume Capdevila
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), IOB Quiron-Teknon, Barcelona, Spain
| | - Desiree’ Deandreis
- Department of Medical Sciences, Nuclear Medicine Unit, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sophie Leboulleux
- Service of Endocrinology, Diabetology, University Hospital Geneve, Geneve, Switzerland
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Susanne Singer
- Institute of Medical Biostatistics Epidemiology and Informatics (IMBEI), University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Beate Bartes
- Association “Vivre sans Thyroïde”, Léguevin, France
| | - Kate Farnell
- Butterfly Thyroid Cancer Trust, Rowlands Gill, Tyne & Wear, UK
| | - Laura Deborah Locati
- Medical Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy
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Wang S, Wang Y, Yu J, Wu H, Zhou Y. Lenvatinib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225525. [PMID: 36428618 PMCID: PMC9688932 DOI: 10.3390/cancers14225525] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 11/12/2022] Open
Abstract
Lenvatinib was approved in 2018 as a first-line treatment for patients with unresectable hepatocellular carcinoma (HCC). This systematic review and meta-analysis aimed to provide the most updated evidence about the efficacy and safety of lenvatinib as a first-line treatment for unresectable HCC. An electronic search of the PubMed database, Web of Science, Embase, and Cochrane Library was undertaken to identify all relevant studies up to May 2022. The pooled effect sizes were calculated based on the random-effects model. One phase III randomized controlled trial and 23 retrospective studies of 2438 patients were eligible for analysis. For patients treated with lenvatinib as first-line treatment, the pooled median overall survival (OS), median progression-free survival (PFS), 1-year OS rate, 1-year PFS rate, objective response rate (ORR), and disease control rate (DCR) were 11.36 months, 6.68 months, 56.0%, 27.0%, 36.0% and 75.0%, respectively. Lenvatinib showed a significantly superior efficacy compared with sorafenib (HR for OS, 0.85 and HR for PFS, 0.72; OR for ORR, 4.25 and OR for DCR, 2.23). The current study demonstrates that lenvatinib can provide better tumor responses and survival benefits than sorafenib as a first-line treatment for unresectable HCC, with a comparable incidence of adverse events.
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Affiliation(s)
- Shijie Wang
- Department of Oncological Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361000, China
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210000, China
| | - Yiting Wang
- Department of Stomatology, People’s Hospital of Zhengzhou, People’s Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Jiangtao Yu
- Department of General Surgery, People’s Hospital of Zhengzhou, People’s Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Huaxing Wu
- Department of Oncological Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361000, China
| | - Yanming Zhou
- Department of Oncological Surgery, First Affiliated Hospital of Xiamen University, Xiamen 361000, China
- Correspondence: ; Tel.: +86-0592-2139708
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