Fournier's Gangrene During Lenvatinib Treatment for Hepatocarcinoma

Antiangiogenic drugs such as lenvatinib have demonstrated significant benefits in patients with hepatocarcinoma (HCC), with an acceptable safety profile. However, serious side effects have been documented, though rare. In this report, we describe the case of a severe and unexpected toxicity encountered after about seven months of lenvatinib treatment. The patient developed a septic state, widespread cutaneous erythema with extensive necrotic involvement of the pelvic floor, with a diagnosis of Fournier's gangrene (FG). Emergency surgery, including sigmoidostomy and wide necrosectomy, was necessary, and further surgeries were performed in the following days due to persistent necrotic tissue. FG is a rare form of necrotizing fasciitis that has been described as rarely associated with several antiangiogenics, even in the absence of major risk factors. Cases of FG have been rarely documented in association with lenvatinib treatment, and this is the first report on a European HCC patient receiving an 8 mg daily dose. Considering the ever-growing use of antiangiogenics in HCC patients and their clinical complexity, it is crucial to be vigilant even about rare toxicities like FG, especially with known concomitant risk factors. Careful monitoring and a multidisciplinary approach are fundamental to promptly identify and address potentially life-threatening complications.