Zhu J, Fang P, Wang C, et al. - Findings corroborate that lenvatinib, a novel multiple receptor tyrosine kinase inhibitor, can improve patients’ immune status, save the effector cells from exhaustion status and inhibit the number and function of immunosuppressive cells, in hepatocellular carcinoma (HCC). Outcomes of patients with lenvatinib therapy can be predicted by the novel index CTL/Treg ratio (the ratio of cytotoxic T lymphocyte/T regulatory).

• This study involved 47 patients with HCC to determine the immunomodulatory capability of lenvatinib in HCC.

• In patients, immune cells and serum cytokine profiles prior to start of treatment and after 1 and 3 months were recorded.

• Following lenvatinib treatment, a reduction in the frequency of T helper cells and T regulatory cells while significant increase in cytotoxic T lymphocyte cells was evident.

• An increase in IL-2, IL-5, IFN-γ, and reduction in other cytokines including IL-6, IL-10, TNF- α and TNF- β was seen with lenvatinib therapy.

• The new index CTL/Treg ratio was developed, and an unfavorable outcome of HCC patients was observed in relation to a low ratio.