Abstract
This study investigated the inhibitory effect of levocarnitine supplementation on sarcopenia progression in hepatocellular carcinoma (HCC) patients treated with lenvatinib. We evaluated the skeletal muscle index (SMI). After propensity score matching for age, sex, modified albumin-bilirubin grade, baseline presence of sarcopenia, and branched-chain amino acid administration, we selected 17 patients who received levocarnitine supplementation after starting lenvatinib therapy and 17 propensity-score-matched patients who did not receive levocarnitine. Sarcopenia was present in 76% of the patients at baseline. Changes in baseline SMI at 6 and 12 weeks of treatment were significantly suppressed in the group with levocarnitine supplementation compared with those without (p = 0.009 and p = 0.018, respectively). While there were no significant differences in serum free carnitine levels in cases without levocarnitine supplementation between baseline and after 6 weeks of treatment (p = 0.193), free carnitine levels were significantly higher after 6 weeks of treatment compared with baseline in cases with levocarnitine supplementation (p < 0.001). Baseline SMI and changes in baseline SMI after 6 weeks of treatment were significantly correlated with free carnitine levels (r = 0.359, p = 0.037; and r = 0.345, p = 0.045, respectively). Levocarnitine supplementation can suppress sarcopenia progression during lenvatinib therapy.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death in Asia [1]
A recent report indicated that loss of skeletal muscle mass in HCC patients treated with lenvatinib influences overall survival and the time to treatment failure [12]
Because our recent clinical study indicated that lenvatinib therapy for HCC provoked lenvatinib-related carnitine insufficiency during treatment, patients treated with lenvatinib began receiving an oral levocarnitine supplementation of 1500 mg per day in March 2020 [19]
Summary
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death in Asia [1]. Systemic therapy using tyrosine kinase inhibitors (TKIs) is an effective treatment strategy for unresectable HCC [1,2]. In cancer patients, including those with HCC, targeted therapies, such as TKIs, can exacerbate muscle wasting and loss of skeletal muscle mass, which is significantly associated with low tolerability of chemotherapy and poor survival [7]. The presence of sarcopenia has been reported to be associated with increased toxicity and prognosis in HCC patients treated with sorafenib [8,9,10,11]. A recent report indicated that loss of skeletal muscle mass in HCC patients treated with lenvatinib influences overall survival and the time to treatment failure [12]. An interventional strategy for sarcopenia progression may be recommended for HCC patients to maintain muscle volume during TKI treatment [14]
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