Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
J Cancer Res Clin Oncol. 2021 Jun;147(6):1747-1756. doi: 10.1007/s00432-020-03448-8. Epub 2020 Nov 22.
PURPOSE: The risk factors and clinical characteristics of ICI-induced immune-mediated hepatotoxicity (IMH) are not fully understood. Thus, the present study sought to clarify the clinical features of IMH. METHODS: All patients treated with ICIs between September 2014 and April 2019 at our institution were included. Clinical data were retrospectively collected from medical records. The frequency of grade ≥ 2 liver damage, clinical characteristics, and risk factors for developing IMH were examined. RESULTS: Overall, 250 patients (median age 71 years; range 30-87 years; 202 males and 48 females) were included in the analyses. Forty-five patients had elevated transaminase levels (> threefold the upper limit of normal). Of these, 21 were considered to have IMH. The remaining 24 patients had other causes of elevated transaminase levels. Steroids were administered to 13/21 patients with IMH. Although all patients exhibited improvement, IMH was not associated with the anticancer efficacy of the ICIs or OS. A multivariable analysis revealed that IMH was significantly associated with malignant melanoma (odds ratio [OR] 11.6; 95% confidence interval [CI] 3.5-38.0; P = 0.0002) and ipilimumab-nivolumab combination therapy (OR 61.2; 95% CI 7.9-1275.3; P < 0.0001). CONCLUSION: Immune-mediated hepatotoxicity occurred in 9.5% of patients treated with ICIs. Appropriate therapeutic interventions are important to avoid affecting the patient's prognosis, and accurate diagnosis of IMH is essential for this purpose. The frequency of IMH varied according to the type of cancer and the drug used, and was significantly higher in patients with malignant melanoma and in patients given ipilimumab-nivolumab combination therapy.
目的:ICI 引起的免疫介导性肝毒性(IMH)的危险因素和临床特征尚未完全阐明。因此,本研究旨在阐明 IMH 的临床特征。
方法:纳入 2014 年 9 月至 2019 年 4 月在我院接受 ICI 治疗的所有患者。回顾性地从病历中收集临床数据。检查了发生 IMH 的肝损伤程度≥2 级的频率、临床特征和危险因素。
结果:总体而言,250 例患者(中位年龄 71 岁;范围 30-87 岁;202 例男性和 48 例女性)纳入分析。45 例患者的转氨酶水平升高(超过正常值上限的三倍)。其中 21 例被认为患有 IMH。其余 24 例患者的转氨酶升高有其他原因。13/21 例 IMH 患者接受了类固醇治疗。尽管所有患者均有改善,但 IMH 与 ICI 的抗癌疗效或 OS 无关。多变量分析显示,IMH 与恶性黑色素瘤显著相关(优势比 [OR] 11.6;95%置信区间 [CI] 3.5-38.0;P=0.0002)和 ipilimumab-nivolumab 联合治疗(OR 61.2;95%CI 7.9-1275.3;P<0.0001)。
结论:ICI 治疗的患者中有 9.5%发生免疫介导性肝毒性。为避免影响患者预后,适当的治疗干预非常重要,准确诊断 IMH 对此至关重要。IMH 的发生频率因癌症类型和所用药物而异,恶性黑色素瘤患者和接受 ipilimumab-nivolumab 联合治疗的患者发生率明显更高。
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