World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Original Article

Volume 000, Number 000, October 2021, pages 000-000

Maximum Plasma Concentration of Lenvatinib Is Useful for Predicting Thrombocytopenia in Patients Treated for Hepatocellular Carcinoma

Figures

Figure 1.
Figure 1. Platelet count of each patient at baseline and after treatment (n = 23). A total of 52.2% (12/23) of the patients had a worsened platelet count grade according to the Common Terminology Criteria for AEs v5.0 (CTCAE v5.0).
Figure 2.
Figure 2. Rate of platelet count decrease, excluding two patients with drug withdrawal (n = 21). The correlations between the rate of platelet count decrease and the Cmax (a), Cmin (b), starting dose (c), and total dose of lenvatinib within 4 weeks of treatment initiation (d) are shown.
Figure 3.
Figure 3. Rates of platelet count decrease in patients without dose modifications within 4 weeks (a, b) (n = 6) as well as in patients with dose modifications within 4 weeks (c, d) (n = 15) of lenvatinib initiation. The correlations between the rate of platelet count decrease and the Cmax as well as the starting dose of lenvatinib are shown.
Figure 4.
Figure 4. Correlation between the Cmax and the predicted Cmax (a) in all patients (n = 23). Correlations between the predicted Cmax and the rate of platelet count decrease (b-d). (b) Patients without drug withdrawal within 4 weeks of lenvatinib initiation (n = 21). (c) Patients without dose modifications within 4 weeks of lenvatinib initiation (n = 6). (d) Patients with dose modifications within 4 weeks of lenvatinib initiation (n = 15).

Tables

Table 1. Baseline Characteristics of Patients (n = 23)
 
CharacteristicNumber or median (range)
ALBI: albumin-bilirubin; BCLC: Barcelona Clinic Liver Cancer.
Age (years)77 (56 - 93)
Sex (male/female)19/4
Body weight (< 60 kg/≥ 60 kg)11/12
Total bilirubin (mg/dL)0.96 (0.4 - 1.9)
Albumin (g/dL)3.5 (2.6 - 4.3)
White blood cell count (/µL)5,070 (2,630 - 8,070)
Platelet count (104/µL)11.1 (5.4 - 23.4)
Prothrombin time (%)86.5 (51.5 - 14.8)
ALBI score-2.13 (-3.03 to -1.35)
Child-Pugh class (A/B/C)15/8/0
BCLC stage (B/C)11/12
Starting dose of lenvatinib (4 mg/8 mg/12 mg)10/8/5

 

Table 2. Adverse Events Within 4 Weeks of Lenvatinib Initiation in All Patients (n = 23)
 
Adverse eventn (%)
Platelet count decrease12 (52.2%)
Hypertension11 (47.8%)
Anorexia11 (47.8%)
Malaise9 (39.1%)
Diarrhea8 (34.8%)
Hypothyroidism6 (26.1%)
White blood cell count decrease5 (21.7%)
Palmar-plantar erythrodysesthesia syndrome3 (13.0%)
Hoarseness3 (13.0%)
Encephalopathy2 (8.7%)
Hemobilia1 (4.3%)
Colitis1 (4.3%)
Creatine increase1 (4.3%)

 

Table 3. Stepwise Multiple Linear Regression Analysis for Creating a Cmax Prediction Formula
 
βSEStandardized βtP-value
R = 0.88, P = 0.027. SE: standard error; Cmax: maximum plasma concentration.
Constant-80.76933.788-2.3900.027
Starting dose (mg)10.1771.4000.7977.271< 0.0001
Albumin (g/dL)23.2199.7120.2622.3910.027