U976, INSERM, Paris, Île-de-France, France
Université Paris Diderot-Paris VII, Université Sorbonne Paris Cité, Paris, Île-de-France, France.
J Immunother Cancer. 2021 Mar;9(3). doi: 10.1136/jitc-2021-002337.
Immune-related hepatitis (IRH) is a frequent but poorly understood immune-related adverse event and its frequency increases since the use of combination therapy in several cancer types. Therefore, there is an urgent need to develop adapted guidelines to manage IRH.In the present letter, based on Ziogas report entitled 'When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report', several points are discussed: assessment of IRH severity and liver biopsy indication, immune-related cholangitis as a differential diagnosis for some IRH presentation, the need of steroids for IRH management or the indication for second line immunosuppressive treatment and finally, the possibility of immunotherapy resumption.
免疫相关性肝炎（IRH）是一种常见但尚未被充分认识的免疫相关性不良事件，随着多种癌症类型联合治疗的应用，其发生率有所增加。因此，迫切需要制定适应的指南来管理 IRH。在这封信中，基于 Ziogas 的报告“在免疫相关性肝炎中，当类固醇不够用时：基于病例报告讨论的当前临床挑战”，讨论了以下几点：IRH 严重程度和肝活检指征的评估、免疫相关性胆管炎作为某些 IRH 表现的鉴别诊断、类固醇治疗 IRH 的必要性或二线免疫抑制治疗的指征，以及免疫治疗是否可以恢复的可能性。
