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Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:

2024 18

Page:

3481-3487

Research Field:

Publishing date:

Info

Title:

Clinical characteristics of immune-mediated liver injury in lung cancer patients treated with anti-PD-1/PD-L1 antibody

Author(s):

ZHU Yue; SONG Jincheng; LI Dan; LIU Xin; YANG Dafu; CUI Saiqiong; WANG Le; DAI Zhaoxia

The Second Department of Thoracic Medical Oncology,the Second Affiliated Hospital of Dalian Medical University,Liaoning Dalian 116021,China.

Keywords:

drug-induced liver injury; immune related adverse events; immune checkpoint inhibitors; immunotherapy

PACS:

R734.2

DOI:

10.3969/j.issn.1672-4992.2024.18.013

Abstract:

Objective:To summarize the clinical characteristics of immune mediated hepatitis (IMH) caused by anti-programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) antibody in lung cancer and provide insights into the diagnosis and treatment of IMH.Methods:Clinical data of lung cancer patients who developed IMH after receiving anti-PD-1/PD-L1 antibody therapy at our hospital from January 2022 to January 2023 were collected.Continuous variables were expressed as median and range,while categorical variables were represented by the number and the percentage of patients.Parametric and non-parametric tests were performed as appropriate.Results:This study included a total of 11 patients,with a median age of 64 years.Smoking may be a risk factor for IMH,and the median time to onset of IMH was 2.1 months after receiving anti-PD-1/PD-L1 therapy.Based on laboratory examination results,we found that compared to alanine transaminase (ALT) and aspartate aminotransferase (AST),the changes in gamma-glutamyl transferase (GGT) and total bile acid (TBA) were more pronounced.The elevation of tumor necrosis factor ¦Á (TNF-¦Á) may be associated with refractory IMH,and a decrease in CD25+ T cell percentage may indicate the occurrence of IMH.The median duration of abnormal ALT/AST levels was 26 days,and the median duration of abnormal total bilirubin (TB) levels was 45 days.If glucocorticoid treatment was ineffective,timely consultation with a hepatologist was recommended to consider the addition of other immunosuppressive agents,while being mindful of potential adverse reactions.Conclusion:Possibly,the elevation of TNF-¦Á could be used as a marker for refractory IMH.The decrease in the percentage of Treg T cells in peripheral blood may be predictive of the occurrence of IMH.In terms of treatment,we recommend to add an intervention level based on CTCAE grading if patients with the elevation of TB and/or GGT in the context of CTCAE grading based on ALT/AST.

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