First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
First Department of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
J Immunother Cancer. 2021 Mar;9(3). doi: 10.1136/jitc-2021-002391.
Immune-related hepatotoxicity (IRH) remains the subject of many immune-oncology debates due to its challenging diagnosis and management. Although it is currently defined by the restrictive Common Terminology Criteria for Adverse Events (CTCAE), the term of IRH covers a wide range of liver pathologies, including hepatitic, cholangitic, mixed, steatotic and nonspecific patterns of injury. Even when liver biopsy is performed, the recognized histopathological findings cannot predict the response to steroids or the need for secondary immunosuppression, and usually do not significantly modify the suggested empirical treatment of IRH. Beyond the CTCAE grading, a more comprehensive assessment of IRH severity, including laboratory biomarkers and clinical features, should be developed and a more patient-oriented management should be established by additional randomized evidence, incorporating hepatology and immune-oncology experience.
免疫相关肝毒性（IRH）因其诊断和管理具有挑战性，仍然是许多肿瘤免疫治疗争论的主题。尽管目前是根据限制性的不良事件通用术语标准（CTCAE）来定义的，但 IRH 这一术语涵盖了广泛的肝脏病理，包括肝炎、胆管炎、混合性、脂肪变性和非特异性损伤模式。即使进行了肝活检，公认的组织病理学发现也不能预测对类固醇的反应或需要二次免疫抑制，并且通常不会显著改变对 IRH 的经验性治疗建议。除了 CTCAE 分级外，还应开发更全面的 IRH 严重程度评估，包括实验室生物标志物和临床特征，并应通过额外的随机证据，结合肝病学和肿瘤免疫学经验，建立更以患者为中心的管理。
