Case Study 2 Patient: A 45-year-old Cantonese-speaking male patient with Child-Pugh B9 liver function and ECOG PS 0 has progressed following 5 months on nivolumab as a second-line treatment for HCC. The patient has a history of hepatitis B infection, which is now well controlled on entecavir, and mild chronic thrombocytopenia (platelet count 110 x 109/L). → Cabozantinib was initiated at a dose of 40 mg owing to the moderate hepatic impairment.* While receiving cabozantinib treatment, the patient developed grade 2 PPE that was intolerable despite supportive care; cabozantinib dosing was interrupted until the PPE resolved to grade 1 or lower, and cabozantinib was restarted at a dose of 20 mg/day. Patient management strategies prior to and during cabozantinib treatment:  Low platelet count may indicate mild portal hypertension; carry out diagnostic tests such as endoscopy to screen for varices   Collaborate with gastroenterology teams on periodic rescreening for varices  If diagnosed, treat portal hypertension with nonselective beta-blockers unless the patient should develop decompensated liver cirrhosis (Child-Pugh C)  Discuss with the patient how to recognize common cabozantinib-associated AEs, how to help prevent these, and when to report them   Source written information in the patient’s native language  Schedule follow-up visits and allocate a team member to carry out follow-up phone calls between visits  Carry out regular DNA testing to monitor for hepatitis B virus reactivation Following development of intolerable grade 2 PPE:  Continue supportive care with topical treatment (see Table 1) and consider addition of oral analgesics *Based on current US prescribing information for cabozantinib [7]; the EU SmPC for cabozantinib does not recommend dose adjustments for moderate hepatic impairment owing to limited data [16].