Cargando…

Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment

In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must b...

Descripción completa

Detalles Bibliográficos
Autores principales: Okuno, Takae, Nakashima, Kazuhisa, Mitarai, Yuki, Kataoka, Masatoshi, Tobita, Hiroshi, Nagase, Mamiko, Isobe, Takeshi, Tsubata, Yukari
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547299/
https://www.ncbi.nlm.nih.gov/pubmed/36217354
http://dx.doi.org/10.1016/j.rmcr.2022.101753
_version_ 1784805234913050624
author Okuno, Takae
Nakashima, Kazuhisa
Mitarai, Yuki
Kataoka, Masatoshi
Tobita, Hiroshi
Nagase, Mamiko
Isobe, Takeshi
Tsubata, Yukari
author_facet Okuno, Takae
Nakashima, Kazuhisa
Mitarai, Yuki
Kataoka, Masatoshi
Tobita, Hiroshi
Nagase, Mamiko
Isobe, Takeshi
Tsubata, Yukari
author_sort Okuno, Takae
collection PubMed
description In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must be discontinued. Since it may be difficult to determine the exact drug causing the hepatitis, liver biopsy may help identify this. We report the case of a patient diagnosed with immune-related adverse event hepatitis from liver biopsy and clinical course. A 45-year-old man with lung adenocarcinoma (stage IV, cT4N3M1c) negative for driver gene mutation was treated with carboplatin (CBDCA), pemetrexed (PEM), and pembrolizumab. Elevated blood aspartate aminotransferase and alanine aminotransferase levels after chemotherapy indicated hepatitis induced by cytotoxic anticancer agents and ICIs. As autoimmune hepatitis was also suspected, liver biopsy was performed and the findings suggested ICI-induced hepatitis. Pembrolizumab was discontinued and CBDCA/PEM was resumed, following which, the primary lesion shrank. When drug-induced hepatitis is suspected, clinicians should actively perform liver biopsy to confirm the diagnosis, so that appropriate therapeutic regimen can be administered.
format Online
Article
Text
id pubmed-9547299
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-95472992022-10-09 Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment Okuno, Takae Nakashima, Kazuhisa Mitarai, Yuki Kataoka, Masatoshi Tobita, Hiroshi Nagase, Mamiko Isobe, Takeshi Tsubata, Yukari Respir Med Case Rep Case Report In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must be discontinued. Since it may be difficult to determine the exact drug causing the hepatitis, liver biopsy may help identify this. We report the case of a patient diagnosed with immune-related adverse event hepatitis from liver biopsy and clinical course. A 45-year-old man with lung adenocarcinoma (stage IV, cT4N3M1c) negative for driver gene mutation was treated with carboplatin (CBDCA), pemetrexed (PEM), and pembrolizumab. Elevated blood aspartate aminotransferase and alanine aminotransferase levels after chemotherapy indicated hepatitis induced by cytotoxic anticancer agents and ICIs. As autoimmune hepatitis was also suspected, liver biopsy was performed and the findings suggested ICI-induced hepatitis. Pembrolizumab was discontinued and CBDCA/PEM was resumed, following which, the primary lesion shrank. When drug-induced hepatitis is suspected, clinicians should actively perform liver biopsy to confirm the diagnosis, so that appropriate therapeutic regimen can be administered. Elsevier 2022-10-04 /pmc/articles/PMC9547299/ /pubmed/36217354 http://dx.doi.org/10.1016/j.rmcr.2022.101753 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Okuno, Takae
Nakashima, Kazuhisa
Mitarai, Yuki
Kataoka, Masatoshi
Tobita, Hiroshi
Nagase, Mamiko
Isobe, Takeshi
Tsubata, Yukari
Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title_full Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title_fullStr Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title_full_unstemmed Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title_short Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
title_sort immune checkpoint inhibitor (ici)-induced hepatitis diagnosed by liver biopsy followed by ici-free chemotherapy leading to therapeutic effect: a case of lung cancer treatment
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547299/
https://www.ncbi.nlm.nih.gov/pubmed/36217354
http://dx.doi.org/10.1016/j.rmcr.2022.101753
work_keys_str_mv AT okunotakae immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT nakashimakazuhisa immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT mitaraiyuki immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT kataokamasatoshi immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT tobitahiroshi immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT nagasemamiko immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT isobetakeshi immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment
AT tsubatayukari immunecheckpointinhibitoriciinducedhepatitisdiagnosedbyliverbiopsyfollowedbyicifreechemotherapyleadingtotherapeuticeffectacaseoflungcancertreatment