Risk factors for lenvatinib-induced palmar-plantar erythrodysesthesia syndrome in patients with hepatocellular carcinoma: A retrospective study

AimLenvatinib mesylate (LEN) is an oral tyrosine kinase inhibitor used to treat various cancers, including hepatocellular carcinoma (HCC). HCC treatment with LEN is associated with a very high incidence of adverse events. This study was aimed at investigating the incidence of LEN-induced palmar-planter erythrodysesthesia syndrome (PPES) and its relationship with patient demographics by analyzing clinical laboratory data of LEN-treated patients with HCC.MethodsThis was a single-centre, retrospective study of patients with HCC who received LEN between April 19, 2018, and September 30, 2020. The observation period was from 1 week before the start of LEN administration to 1 month after the end of administration.ResultsOverall, 75 patients with HCC were enrolled. LEN-induced PPES was found in 48.0% (36/75 patients). In these patients, alkaline phosphatase (ALP), gamma-Glutamyl transpeptidase (gamma-GTP) and monocytes (MONO) were significantly high (ALP: p = 1.32 x 10-3, gamma-GTP: p = 4.25 x 10-3 and MONO: p = 0.013). The cut off values of ALP, gamma-GTP and MONO for LEN-induced PPES were estimated at 573 U/L, 89 U/L, and 310 counts/mu L, respectively. In the multivariate analysis, gamma-GTP and MONO were independent risk factors for LEN-induced PPES.ConclusionsHigh gamma-GTP and high MONO were risk factors for LEN-induced PPES.