Tsuchiya K, et al. - Researchers performed a retrospective nationwide multicenter study to report on lenvatinib (LEN) therapy in patients with unresectable hepatocellular carcinoma (u-HCC). At 14 sites in Japan, a total of 116 u-HCC patients were registered to receive LEN from March 2018; median age 72 (46-91) years; 88 (75.9%) males; median body weight 60 (30-94) kg. in 106 (91.4%) patients, the baseline liver function was Child-Pugh class A. Seventy-three (62.9%) patients were BCLC stage C. Twenty eight (24.1%) patients received LEN as the 2nd-line therapy (after sorafenib) and 17 (14.7%) patients did as the 3rd-line (after regorafenib). In line with phase 3 clinical trial, findings support the efficacy of LEN therapy in real world practice in Japan, even though elderly patients with lower body weight were included in this study. In real world practice, lower incidence of hand-food skin reaction (HFSR) during LEN was observed compared to that observed in the sorafenib group in the phase 3 trial of LEN. They recommend careful monitoring and managing decrease appetite and fatigue during LEN therapy.