In hepatocellular carcinoma, the hypoxia-responsive PPARGC1A (peroxisome proliferator activated receptor gamma coactivator 1 alpha)/BAMBI (bone morphogenetic protein and activin membrane bound inhibitor)/ACSL5 (acyl-CoA synthetase long chain family member 5) pathway confers lenvatinib resistance[81]. The gene discussed is ACSL5; the disease is hepatocellular carcinoma.