仑伐替尼在肝癌治疗中的药物相关不良反应及临床管理

Drug-Related Adverse Events and Clinical Management of Lenvatinib in the Treatment of Hepatocellular Carcinoma

摘要: 仑伐替尼(lenvatinib)作为多靶点酪氨酸激酶抑制剂，在不可切除肝细胞癌(HCC)一线治疗中显著提升了疾病控制率和无进展生存期。然而，其多靶点作用机制亦伴随复杂的不良反应谱，包括高血压、蛋白尿、胃肠道毒性、肝毒性及甲状腺功能减退，少数患者甚至可发生可逆性后部脑病综合征、消化道穿孔等严重事件。这些不良反应不仅影响患者生活质量，亦是治疗中断和剂量调整的主要原因。本综述为叙事性综述，基于对PubMed、Web of Science及中国知网数据库的检索，时间范围为2015年至2025年，检索关键词包括“lenvatinib”“hepatocellular carcinoma”“adverse events”等，并结合临床试验与真实世界研究，系统归纳了仑伐替尼在HCC治疗中的不良反应发生特点、潜在机制及临床管理策略。本文强调，早期识别、规律监测及多学科干预对于优化疗效与安全性至关重要，可为临床个体化管理及改善长期生存预后提供参考。

Abstract: Lenvatinib, a multi-target tyrosine kinase inhibitor, has significantly improved disease control rates and progression-free survival in the first-line treatment of unresectable hepatocellular carcinoma (HCC). However, its multi-target mechanism of action is associated with a complex spectrum of adverse events (AEs), including hypertension, proteinuria, gastrointestinal toxicity, hepatotoxicity, and hypothyroidism, with rare but severe complications such as reversible posterior leukoencephalopathy syndrome and gastrointestinal perforation. These AEs not only impair patients’ quality of life but also represent major causes of treatment interruption and dose modification. This narrative review was conducted based on a literature search of PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases for studies published from 2015 to 2025, using keywords such as “lenvatinib” “hepatocellular carcinoma” and “adverse events”. Drawing on evidence from both clinical trials and real-world studies, we comprehensively summarize the incidence patterns, potential mechanisms, and clinical management strategies of lenvatinib-associated AEs in HCC treatment. We highlight that early identification, regular monitoring, and multidisciplinary intervention are essential for optimizing therapeutic efficacy and safety, thereby supporting individualized patient management and improving long-term survival outcomes.