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

Abstract Aim Lenvatinib 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. Methods This 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. Results Overall, 75 patients with HCC were enrolled. LEN‐induced PPES was found in 48.0% (36/75 patients). In these patients, alkaline phosphatase (ALP), γ‐Glutamyl transpeptidase (γ‐GTP) and monocytes (MONO) were significantly high (ALP: p = 1.32 × 10−3, γ‐GTP: p = 4.25 × 10−3 and MONO: p = 0.013). The cut off values of ALP, γ‐GTP and MONO for LEN‐induced PPES were estimated at 573 U/L, 89 U/L, and 310 counts/μL, respectively. In the multivariate analysis, γ‐GTP and MONO were independent risk factors for LEN‐induced PPES. Conclusions High γ‐GTP and high MONO were risk factors for LEN‐induced PPES.