Therapeutic Drug Monitoring of Sorafenib and Lenvatinib in Hepatocellular Carcinoma Patients – A Key to Personalised Pharmacotherapy

Abstract

Cancer remains a public concern and leading cause of death worldwide. Hepatocellular carcinoma, the most common form of liver cancer, is the third leading cause of cancer-related deaths. The number of cases is expected to double by 2040, according to GLOBOCAN 2020. Patients are usually diagnosed with advanced-stage HCC, which limits the number of effective treatment options. Oral-targeted therapies involving sorafenib and lenvatinib remain the first-line treatment option, which has recently been replaced by immunotherapy. Due to economic issues and ease of administration, the vast majority prefer oral systemic therapy. Sorafenib and lenvatinib, which belongs to tyrosine kinase inhibitors have few limitations of having large inter-individual variability in absorption, genetic polymorphisms, poor patient adherence to oral regimen limiting its long-term therapy. Therapeutic Drug Monitoring can overcome the limitations of TKIs and help individualise the dosage regimen with minimal adverse events. Therefore, this simple and rapid method using latest equipment enabled with ultra-high speed, high-sensitivity analysis (LCMS-8045) is expected to bring a change in clinical practice to improve the efficacy and safety of medication for optimal patient benefits.