Severe Ulcerative Skin Lesions Due to Lenvatinib

Abstract

Lenvatinib is an antiangiogenic tyrosine kinase inhibitor that effectively treats advanced hepatocellular carcinoma. However, lenvatinib has several side effects, including hand-foot skin reactions. A 70-year-old female patient with hepatocellular carcinoma measuring 9 cm in diameter was referred to our hospital. Her liver function showed Child-Pugh grade A, and lenvatinib was started (8 mg daily). After 4 weeks, both of her hands and feet showed several blisters and necrotic lesions. Lenvatinib was temporarily discontinued. Four weeks later, her syndrome improved, and lenvatinib was reinstituted at 4 mg daily. Painful hand-foot syndrome reemerged during the next three weeks and simultaneously, an ulcerative left thigh skin lesion occurred (Figure A and B). Lenvatinib was discontinued, and prostaglandin ointments were administered. Four weeks later, her hand-foot syndrome and ulcerative skin lesion disappeared (Figure C and D). Painful skin lesions as an adverse effect of lenvatinib usually present on keratinized areas of the palms and soles. The precise mechanism by which lenvatinib causes hand-foot syndrome is not understood, but impairment in repair via platelet-derived growth factor receptor inhibition may play a role. The skin lesion side effect of lenvatinib can occur in keratinized areas of palms and soles and in soft skin tissues across the whole body.