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Lenvatinib + FOLFOX4 is a combination therapy being investigated as an adjuvant treatment to prevent recurrence of hepatocellular carcinoma (HCC) in patients who have undergone liver transplantation and are beyond the Milan criteria. FOLFOX4 is a chemotherapy regimen consisting of oxaliplatin, leucovorin (folinic acid), and 5-fluorouracil (5-FU). Oxaliplatin causes DNA cross-linking, 5-FU inhibits thymidylate synthase to disrupt DNA synthesis, and leucovorin enhances the binding of 5-FU to its target. Lenvatinib is an oral multi-kinase inhibitor that targets vascular endothelial growth factor receptors (VEGFR1-3), fibroblast growth factor receptors (FGFR1-4), platelet-derived growth factor receptor alpha (PDGFRα), KIT, and RET. This combination aims to provide both systemic cytotoxic effects and targeted anti-angiogenic/anti-proliferative activity to eliminate residual micrometastases post-transplant.
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