Uchida-Kobayashi S, Kageyama K, Yamamoto A, et al. - Given that lenvatinib has been approved as systemic therapy for patients with unresectable hepatocellular carcinoma (HCC), researchers conducted this retrospective single-center study to analyze full details of lenvatinib-induced tumor-related hemorrhage in patients with HCC since this is something patients have recently been experiencing. The sample consisted of 68 consecutive patients treated with lenvatinib for unresectable HCC from April 2018 to February 2020. Five of these patients developed intraperitoneal or intratumoral hemorrhages; these patients had larger tumors than the ones without. Compared to the patients without hemorrhage, the dosing period of lenvatinib and the survival time from initial administration of lenvatinib was shorter vs those with hemorrhage. It is clear that, despite rapid suppression of tumor blood flow, treatment with lenvatinib brings on tumor-related hemorrhages. The authors assume that lenvatinib rapidly blocks the feeding circulation, resulting in tumor hemorrhage by necrosis. When treating large HCCs with lenvatinib, physicians should pay close attention to the development of life-threatening hemorrhages.