Toshifumi Tada1, Takashi Kumada1, Atsushi Hiraoka2, Kojiro Michitaka2, Masanori Atsukawa3, Masashi Hirooka4, Kunihiko Tsuji5, Toru Ishikawa6, Koichi Takaguchi7, Kazuya Kariyama8, Ei Itobayashi9, Kazuto Tajiri10, Noritomo Shimada11, Hiroshi Shibata12, Hironori Ochi13, Hidenori Toyoda1, Kazuhiro Nouso8, Akemi Tsutsui7, Takuya Nagano7, Norio Itokawa3, Korenobu Hayama3, Michitaka Imai6, Kouji Joko13, Yohei Koizumi4, Yoichi Hiasa4. 1. Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan. 2. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan. 3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. 4. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan. 5. Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan. 6. Department of Gastroenterology, Saiseikai Niigata Daini Hospital, Niigata, Japan. 7. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 8. Department of Gastroenterology, Okayama City Hospital, Okayama, Japan. 9. Department of Gastroenterology, Asahi General Hospital, Asahi, Japan. 10. Department of Gastroenterology, Toyama University Hospital, Toyama, Japan. 11. Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan. 12. Department of Gastroenterology, Tokushima Prefectural Central Hospital, Tokushima, Japan. 13. Hepato-biliary Center, Matsuyama Red Cross Hospital, Matsuyama, Japan.
Abstract
AIM: Lenvatinib has become available as first-line therapy for patients with unresectable hepatocellular carcinoma (HCC). However, the safety and efficacy of lenvatinib in elderly patients with HCC has not been sufficiently investigated. We compared the frequency of adverse events and prognosis between elderly and non-elderly patients with HCC who received lenvatinib. METHODS: A total of 100 patients with HCC who received lenvatinib were selected using propensity score matching: 50 patients were elderly (age ≥75 years) and 50 patients were non-elderly. RESULTS: In the elderly group, >20% of patients experienced fatigue (36.0%), decreased appetite (26.0%), hypothyroidism (24.0%), proteinuria (22.0%), palmar-plantar erythrodysesthesia (22.0%), and hypertension (20.0%) of any grade as treatment-related adverse events. In addition, >10% of patients experienced grade ≥3 treatment-related fatigue (12.0%). In the non-elderly group, >20% of patients experienced palmar-plantar erythrodysesthesia (42.0%), fatigue (28.0%), decreased appetite (22.0%), and diarrhea (20.0%) of any grade as treatment-related adverse events. In addition, >10% of patients experienced grade ≥3 treatment-related proteinuria (10.0%). There were no significant differences between the elderly and non-elderly groups in the frequency of adverse events. Regarding overall and progression-free survival, there were no significant differences between the elderly and non-elderly groups (hazard ratio 0.972, 95% confidence interval 0.374-2.529; and hazard ratio 1.362, 95% confidence interval 0.687-2.700, respectively). Palmar-plantar erythrodysesthesia (hazard ratio 0.117, 95% confidence interval 0.015-0.916) was independently associated with overall survival in a multivariate analysis. CONCLUSIONS: Lenvatinib can be used safely and efficaciously regardless of age in patients with HCC.
AIM: Lenvatinib has become available as first-line therapy for patients with unresectable hepatocellular carcinoma (HCC). However, the safety and efficacy of lenvatinib in elderly patients with HCC has not been sufficiently investigated. We compared the frequency of adverse events and prognosis between elderly and non-elderly patients with HCC who received lenvatinib. METHODS: A total of 100 patients with HCC who received lenvatinib were selected using propensity score matching: 50 patients were elderly (age ≥75 years) and 50 patients were non-elderly. RESULTS: In the elderly group, >20% of patients experienced fatigue (36.0%), decreased appetite (26.0%), hypothyroidism (24.0%), proteinuria (22.0%), palmar-plantar erythrodysesthesia (22.0%), and hypertension (20.0%) of any grade as treatment-related adverse events. In addition, >10% of patients experienced grade ≥3 treatment-related fatigue (12.0%). In the non-elderly group, >20% of patients experienced palmar-plantar erythrodysesthesia (42.0%), fatigue (28.0%), decreased appetite (22.0%), and diarrhea (20.0%) of any grade as treatment-related adverse events. In addition, >10% of patients experienced grade ≥3 treatment-related proteinuria (10.0%). There were no significant differences between the elderly and non-elderly groups in the frequency of adverse events. Regarding overall and progression-free survival, there were no significant differences between the elderly and non-elderly groups (hazard ratio 0.972, 95% confidence interval 0.374-2.529; and hazard ratio 1.362, 95% confidence interval 0.687-2.700, respectively). Palmar-plantar erythrodysesthesia (hazard ratio 0.117, 95% confidence interval 0.015-0.916) was independently associated with overall survival in a multivariate analysis. CONCLUSIONS:Lenvatinib can be used safely and efficaciously regardless of age in patients with HCC.
Authors: Melchiorre Cervello; Maria R Emma; Giuseppa Augello; Antonella Cusimano; Lydia Giannitrapani; Maurizio Soresi; Shaw M Akula; Stephen L Abrams; Linda S Steelman; Alessandro Gulino; Beatrice Belmonte; Giuseppe Montalto; James A McCubrey Journal: Aging (Albany NY) Date: 2020-02-04 Impact factor: 5.682