Proactive Management Key to Addressing TKI Adverse Events in HCC

Pierre Gholam, MD, associate professor of medicine at Case Western Reserve University School of Medicine, and director of the multidisciplinary hepatobiliary tumor team at University Hospitals Seidman Cancer Center in Cleveland, Ohio, discusses his approach to recognizing and managing adverse events (AEs) in patients receiving tyrosine kinase inhibitors (TKIs) for hepatocellular carcinoma.

Gholam says that it is important for patients to remain on therapy. The effectiveness of dose reductions and brief interruptions in enabling this makes it a normal part of AE management.

For lenvatinib (Lenvima), which can cause hypertension, patients’ baseline blood pressure should be considered, and they should be monitored for the first 4 to 6 weeks. He recommends oncologists prescribe antihypertensives such as calcium channel blockers or beta blockers themselves rather than asking another physician to treat the hypertension.

Other difficult-to-manage AEs with TKIs include asthenia, loss of appetite, and fatigue; Gholam says that recognizing them early can help to provide the proper dose modification or supportive care.

TRANSCRIPTION

0:10 | I find that dose reductions and brief dose interruptions are the rule, not the exception. That is certainly something that patients should receive in order to enable them to stay on therapy. I think that prescribers should not shy away from doing that if the goal is to enable patients to stay on treatment, and they should certainly avail themselves of that tool in addition to treating a specific complication.

0:42 | By far the most common complication of lenvatinib, for example, is hypertension. People with high blood pressure with lenvatinib could have this addressed relatively straightforwardly through a combination of proactive diagnosis before initiation of therapy, very close monitoring of blood pressure in the first 4 to 6 weeks—which is when this typically declares itself—and initiating an antihypertensive. I would urge all my colleagues, whether in medical oncology or specialties that prescribe this drug, to take ownership of [management] themselves, as opposed to offshoring this to a primary care doctor or a family physician. My go-to certainly in that setting would be a calcium channel blocker or sometimes a beta blocker. So there certainly are plenty of tools that we can use to manage this.

1:38 | There are, of course, other, I would say, more challenging [AEs] to address, including asthenia, loss of appetite, and fatigue, of course. These are cardinal AEs related to TKIs in general, and they can be thorny to tackle, but I think recognizing them early may be important in order to be able to address them properly.