Colitis induced by Lenvatinib in a patient with advanced hepatocellular carcinoma
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CASE REPORT
Colitis induced by Lenvatinib in a patient with advanced hepatocellular carcinoma Saori Miyajima1 · Kunihiro Tsuji1 · Yosuke Kito1 · Naohiro Yoshida1 · Kazuhiro Matsunaga1 · Shigetsugu Tsuji1 · Kazuyoshi Katayanagi2 · Miwa Yonezawa3 · Anna Kubo3 · Kahori Ushijima3 · Hiroshi Minato2 · Hisashi Doyama1 Received: 10 July 2020 / Accepted: 17 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Lenvatinib is a standard molecular targeted agent for the first-line treatment of unresectable hepatocellular carcinoma. Here, we report a case of colitis induced by Lenvatinib treatment in a patient with hepatocellular carcinoma. A 78-year-old man previously treated with Lenvatinib for unresectable hepatocellular carcinoma was admitted to our hospital complaining of right lateral abdominal pain without diarrhea. Our endoscopic findings showed multiple ulcers and erosions on his ascending colon, and he was diagnosed with colitis induced by Lenvatinib treatment. After the discontinuation of Lenvatinib, his colitis improved, and he resumed Lenvatinib at a lower dose. Colitis is a rare adverse event of Lenvatinib, and this is the first detailed report of colitis induced by Lenvatinib with endoscopic findings. Keywords Lenvatinib · Colitis · Hepatocellular carcinoma · Multikinase inhibitor
Introduction Lenvatinib is an oral antineoplastic agent and a multikinase inhibitor that targets vascular endothelial growth factor receptors (VEGFR)1–3, fibroblast growth factor receptors (FGFR)1–4, platelet-derived growth factor receptor-alpha, rearranged during transfection (RET), and KIT [1–4]. Lenvatinib has been approved for the treatment of radioiodinerefractory differentiated thyroid cancer [5]. A pivotal phase III trial showed that Lenvatinib was non-inferior to sorafenib in terms of overall survival for patients with unresectable hepatocellular carcinoma (HCC) [6]. In that trial, patients treated with Lenvatinib showed a statistically significant improvement in progression-free survival time to progression, and objective response rates compared with sorafenib [6]. Therefore, Lenvatinib has become one of the standard * Kunihiro Tsuji [email protected] 1
Departments of Gastroenterology, Ishikawa Prefectural Central Hospital, 2‑1 Kuratukihigashi, Kanazawa, Ishikawa 920‑8530, Japan
2
Departments of Pathology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
3
Departments of Pharmacy, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
molecular targeted agents for the first-line treatment of unresectable HCC. The common adverse events associated with Lenvatinib include hypertension, diarrhea, decreased appetite, decreased weight, and others [6]. Colitis is a rare adverse event of Lenvatinib. To the best of our knowledge, and there are previous case reports of colitis related to other multikinase inhibitors [7, 8], but there are no reports of colitis or detailed endoscopic findings in patients treated with Lenvatinib. Here, we report a case of colitis induced by Lenvatinib treatment in
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