Inclusion Criteria

Inclusion Criteria

1. Subjects must have confirmed diagnosis of unresectable HCC

2. At least 1 measurable target lesion

3. Subjects categorized to stage B (not applicable for transarterial chemoembolization
[TACE]) stage C based on Barcelona Clinic Liver Cancer (BCLC) staging system

4. Adequate bone marrow function

5. Adequate liver function

6. Adequate blood coagulation function

8. Adequately controlled blood pressure (BP) with 0 or 1 antihypertensive medications 9.
Child-Pugh score A 10. ECOG-PS 0 or 1 11. Survival expectation of 12 weeks or longer after
starting study drug 12. Males or females aged at least 18 years (or any age greater than
18 years as determined by country legislation) at the time of informed consent

Exclusion Criteria

1. Imaging findings for HCC corresponding to any of the following:

- HCC with greater than or equal to 50% liver occupation

- Clear invasion into the bile duct

- Portal vein invasion at the main portal branch (Vp4)

2. Subjects who have received any systemic chemotherapy, including sorafenib, or any
systemic investigational anticancer agents, including lenvatinib, for
advanced/unresectable HCC. Note: Subjects who have received local hepatic injection
chemotherapy are eligible.

3. Subjects who have received any anticancer therapy (including surgery, percutaneous
ethanol injection, radio frequency ablation, transarterial [chemo] embolization,
hepatic intra-arterial chemotherapy, biological, immunotherapy, hormonal, or
radiotherapy) or any blood enhancing treatment (including blood transfusion, blood
products, or agents that stimulate blood cell production, e.g., granulocyte
colony-stimulating factor [G-CSF]) within 28 days prior to randomization

4. Gastrointestinal malabsorption or any other condition that might affect the
absorption of lenvatinib in the opinion of the investigator

5. Bleeding or thrombotic disorders or use of anticoagulants such as, warfarin or
similar agents requiring therapeutic INR monitoring. (Treatment with low molecular
weight heparin is allowed.)

6. Gastrointestinal bleeding event or active hemoptysis (bright red blood of at least
0.5 teaspoon) within 28 days prior to randomization

7. Gastric or esophageal varices that require treatment

8. Meningeal carcinomatosis

9. Subjects having >1 + proteinuria on urine dipstick testing will undergo 24 h urine
collection for quantitative assessment of proteinuria. Subjects with urine protein
greater than or equal to 1 g/24 h will be ineligible.

10. Arterial-portal venous shunt or arterial-venous shunt preventing proper diagnosis of
tumor

11. Any medical or other condition that in the opinion of the investigator would preclude
the subject's participation in a clinical study

12. Any history of drug or alcohol dependency or abuse within the prior 2 years

13. Major surgery within 3 weeks prior to randomization or scheduled for surgery during
the study

14. Subject has had a liver transplant