Godbert Benoit, Petitpain Nadine, Lopez Anthony, Nisse Yann-Eric, Gillet Pierre
Department of Pneumology, Robert Schuman Hospital, Vantoux 57070, France.
Regional Pharmacovigilance Centre, Department of Clinical Pharmacology, Toxicology, University Hospital CHRU Nancy, Vandœuvre-lès-Nancy 54511, France.
Dig Liver Dis. 2021 Apr;53(4):452-455. doi: 10.1016/j.dld.2020.08.041. Epub 2020 Sep 10.
Liver toxicity during immune checkpoint inhibitor treatment is mostly due to immune mediated hepatitis. Viral hepatitis, as well as auto-immune or metabolic hepatitis, are considered as exclusion criteria for ICI induced immune hepatitis diagnosis. However, considering the high prevalence of viral hepatitis B infection and the increasing prescription of immune checkpoint inhibitors, their use in patients with HBV chronic viral infection may be common, even more if patients are treated for hepatocellular carcinoma. Few clinical studies directly deal with the risk of HBV reactivation during ICI therapy and real-life data is currently based on five reported cases of HBV reactivation, one with fatal outcome. In this review, we summarize the current available clinical information about HBV reactivation risk during ICI treatment, its hypothetic mechanism, and propose practical recommendations about verifying and monitoring HBV status throughout the treatment.
免疫检查点抑制剂治疗期间的肝毒性主要归因于免疫介导的肝炎。病毒性肝炎以及自身免疫性或代谢性肝炎被视为免疫检查点抑制剂诱导的免疫性肝炎诊断的排除标准。然而，鉴于乙肝病毒感染的高流行率以及免疫检查点抑制剂处方的增加，它们在慢性乙肝病毒感染患者中的使用可能很常见，尤其是在患者接受肝细胞癌治疗时。很少有临床研究直接涉及免疫检查点抑制剂治疗期间乙肝病毒再激活的风险，目前的实际数据基于五例报告的乙肝病毒再激活病例，其中一例导致死亡。在本综述中，我们总结了目前关于免疫检查点抑制剂治疗期间乙肝病毒再激活风险的可用临床信息、其假设机制，并提出了在整个治疗过程中验证和监测乙肝病毒状态的实用建议。
