Pembrolizumab
is
an
immune
checkpoint
inhibitor
(ICI)
that
demonstrated
to
enhance
the
prognosis
of
patients
with
advanced
lung
cancer.
However,
adding
immunotherapy
clinical
practice
has
brought
new
challenges,
such
as
immune-related
adverse
events
(irAEs),
which
have
changed
chemotherapy's
previously
well-understood
safety
profile.
Immune-mediated
hepatitis,
although
less
prevalent
and
extensively
studied,
represents
a
significant
toxicity
may
evolve
into
potentially
severe
complication,
particularly
when
it
becomes
refractory
conventional
treatments.
In
this
report,
we
present
case
67-year-old
male
patient
non-small
cell
cancer
who
developed
corticosteroid
(CS)-refractory
hepatitis
following
two
cycles
pembrolizumab.
Differential
diagnosis
workup
excluded
alternative
diagnosis.
A
liver
biopsy
evidenced
both
cholestasis.
Due
persistent
cytolysis,
was
necessary
add
mycophenolate
mofetil
(MMF).
Additionally,
ursodeoxycholic
acid
(UDCA)
introduced
due
cholestasis,
resulting
in
normalization
laboratory
parameters.
The
lack
prospective
evidence
regarding
treatment
makes
challenging
draw
definitive
conclusions
about
optimal
therapeutic
approach.
Hepatology Communications,
Год журнала:
2024,
Номер
8(10)
Опубликована: Сен. 18, 2024
Background:
In
recent
years,
the
use
of
immune
checkpoint
inhibitors
(ICIs)
has
become
a
cornerstone
in
cancer
treatment.
However,
this
also
resulted
emergence
immune-related
adverse
events,
notably
ICI
hepatitis,
posing
significant
clinical
challenge.
While
steroids
are
primary
treatment,
there
increasing
cases
steroid-refractory
hepatitis.
Our
objective
is
to
investigate
management
hepatitis
and
its
response
steroid
Methods:
PubMed/MEDLINE,
EMBASE,
CENTRAL
databases
were
searched
July
2023
based
on
keywords
including
ICIs
(anti–Programmed
cell
death
protein
1/Programmed
Death-Ligand
1,
anti–CTLA–4,
anti-LAG3)
Results:
A
total
4358
studies
screened,
44
included
systematic
review.
One
thousand
eight
hundred
fifty-six
patients
with
(grade
1-2:
31.7%,
grade
3-4:
56.0%,
unknown:
12.3%)
1184
who
received
corticosteroid
The
duration
treatment
dosage
varied
considerably
across
studies.
Mycophenolate
mofetil
was
predominant
agent
used
68
out
82
(82.9%),
followed
by
infliximab
azathioprine.
summary
estimate
proportion
random
effects
model
16%
(95%
CI:
11%–23%).
An
estimated
40%
30%–51%)
all
rechallenged
an
ICI,
those
rechallenged,
22%
15%–30%)
recurrence.
Conclusions:
Corticosteroids
for
mycophenolate
as
secondary
option
steroids-refractory
cases.
Current
practices
mostly
rely
expert
consensus,
highlighting
need
further
research
validate
optimize
these
treatments,
particularly
steroid-resistant
Pembrolizumab
is
an
immune
checkpoint
inhibitor
(ICI)
that
demonstrated
to
enhance
the
prognosis
of
patients
with
advanced
lung
cancer.
However,
adding
immunotherapy
clinical
practice
has
brought
new
challenges,
such
as
immune-related
adverse
events
(irAEs),
which
have
changed
chemotherapy's
previously
well-understood
safety
profile.
Immune-mediated
hepatitis,
although
less
prevalent
and
extensively
studied,
represents
a
significant
toxicity
may
evolve
into
potentially
severe
complication,
particularly
when
it
becomes
refractory
conventional
treatments.
In
this
report,
we
present
case
67-year-old
male
patient
non-small
cell
cancer
who
developed
corticosteroid
(CS)-refractory
hepatitis
following
two
cycles
pembrolizumab.
Differential
diagnosis
workup
excluded
alternative
diagnosis.
A
liver
biopsy
evidenced
both
cholestasis.
Due
persistent
cytolysis,
was
necessary
add
mycophenolate
mofetil
(MMF).
Additionally,
ursodeoxycholic
acid
(UDCA)
introduced
due
cholestasis,
resulting
in
normalization
laboratory
parameters.
The
lack
prospective
evidence
regarding
treatment
makes
challenging
draw
definitive
conclusions
about
optimal
therapeutic
approach.
