Clinical and literature case analysis on resumption of immunotherapy following severe liver injury related to immune checkpoint inhibitors
10.3760/cma.j.cn114015-20231220-00921
- VernacularTitle:免疫检查点抑制剂相关严重肝损伤后重启免疫治疗的临床及文献病例分析
- Author:
Kongcai ZHU
1
;
Wei LIU
1
Author Information
1. 首都医科大学附属北京佑安医院药学部，北京 100069
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Chemical and drug induced liver injury;
Immune mediated hepatitis;
Retreatment;
Risk of recurrence
- From:
Adverse Drug Reactions Journal
2024;26(6):363-368
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety of restarting immunotherapy in patients with ≥grade 3 immune checkpoint inhibitor-related immune mediated hepatitis (IMH).Methods:The diagnosis and treatment of a patient with grade 4 IMH and restarting immunotherapy who was admitted to Beijing Youan Hospital, Capital Medical University was reported, and the main clinical data of the patient and related cases collected from PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases (as of November 2023) were analyzed statistically from 5 aspects such as the study type, initial immunotherapy, severity of liver toxicity, resumption of immunotherapy, and recurrence rate of IMH after restarting immunotherapy.Results:A total of 17 relevant literature were collected, including 13 retrospective case series studies, 1 prospective study, and 3 case reports. One hundred and eleven patients who experienced ≥grade 3 IMH and restarted treatment with immune checkpoint inhibitors (ICIs) were extracted. Along with one case reported by our hospital, there were totally 112 cases. After restarting ICIs treatment, the recurrence rate of IMH was 22.3% (25/112). The recurrence rate in patients with cytotoxic T lymphocyte associated antigen 4 (CTLA-4) inhibitors in the ICIs treatment regimen was higher than those without CTLA-4 inhibitors, and the difference were not statistically significant [30.0% (6/20) vs. 21.1% (19/90), χ2=0.736, P=0.279]. The recurrence rate of IMH in patients with original treatment regimen was higher than those with adjusted treatments, and the difference were not statistically significant [22.2%(6/27) vs. 17.4%(8/46), χ2=0.256, P=0.613]. Conclusion:Restarting ICIs treatment in patients with ≥grade 3 ICI-related IMH after weighing the pros and cons may benefit some patients.
