Liver toxicity as a limiting factor to the increasing use of immune checkpoint inhibitors

JHEP Reports : Innovation in Hepatology
Eleonora De MartinDidier Samuel

Abstract

Immune checkpoint inhibitors (ICIs) improve clinical outcomes in patients suffering from different types of cancer. Liver toxicity is one of the immune-related adverse events associated with immunotherapy; although not common, its management is challenging as it is extremely heterogeneous in terms of presentation and severity. Differences in the development and evolution of ICI-related toxicity in healthy or cirrhotic livers have not yet been elucidated. Assessing causality is key to diagnosing ICI-induced liver toxicity; liver biopsies can assist not only in the differential diagnosis but also in assessing the severity of histological liver damage. The current classification of severity overestimates the grade of liver injury and needs to be revised to reflect the views of hepatologists. Spontaneous improvements in ICI-related liver toxicity have been reported, so corticosteroid therapy should probably be individualised not systematic. The reintroduction of ICIs in a patient with previous immune-mediated hepatitis may be possible, but the risk/benefit ratio should be considered, as the risk factors for hepatitis recurrence are currently unclear. The management of these patients, requiring a balance between efficacy, toxicity a...Continue Reading

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Citations

Mar 20, 2021·Journal for Immunotherapy of Cancer·Dimitrios C Ziogas, Helen Gogas
Apr 4, 2021·European Journal of Medical Genetics·Bastian EngelMarcial Sebode
May 1, 2021·International Journal of Molecular Sciences·Alessio GerussiPietro Invernizzi
Dec 1, 2020·Pharmacology & Therapeutics·Bingjian WenZhengquan Su
Jul 3, 2021·Cancers·Hideki Iwamoto On Behalf Of The Kurume Liver Cancer Study Group Of Japan
Jul 18, 2021·Thoracic Cancer·Naoki ShijubouHirofumi Chiba
Sep 18, 2021·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Joseph William ClintonJames H Lewis

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Methods Mentioned

BETA
biopsies
biopsy
prophylactic therapy

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