Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1X6, Canada.
Department of Medical Oncology, Hospital de Base, Sao Jose do Rio Preto 15090 000, Brazil.
Curr Oncol. 2021 Jun 11;28(3):2173-2179. doi: 10.3390/curroncol28030201.
Current guidelines state that infliximab is contraindicated for the treatment of immune checkpoint inhibitor-related hepatitis (ir-hepatitis) due to the risk of inducing further liver damage. As this recommendation is largely based on the use of infliximab for rheumatologic diseases, we evaluated the efficacy and hepatotoxicity of infliximab in patients with steroid-refractory immune-related adverse events (irAEs).
We retrospectively reviewed consecutive patients treated with infliximab for irAEs at Princess Margaret Cancer Centre. To assess hepatotoxicity, we compared the mean value of ALT, AST, and total bilirubin (BT) before and after infliximab treatment. We used logistic regression to assess factors associated with infliximab efficacy.
Between January 2010 and February 2019, 56 patients were identified. The median age of the patients was 63 (27-84) years. Colitis was the most frequent toxicity (66%), followed by pneumonitis (11%). Infliximab was used to treat ir-hepatitis in one patient. The median number of infliximab doses was 1 (1-3) and led to toxicity resolution in 43 (76%) patients. The mean ALT, AST, and BT levels before and after infliximab treatment were not statistically different. The patient treated for ir-hepatitis had a complete recovery, with no incremental liver toxicity.
In this dose-limited setting, infliximab was effective in resolving irAEs and did not induce hepatotoxicity.
目前的指南指出，由于可能导致进一步的肝损伤，英夫利昔单抗禁用于治疗免疫检查点抑制剂相关肝炎（ir-hepatitis）。由于该建议主要基于英夫利昔单抗在风湿性疾病中的应用，我们评估了英夫利昔单抗在类固醇难治性免疫相关不良事件（irAEs）患者中的疗效和肝毒性。
我们回顾性地审查了在玛格丽特公主癌症中心接受英夫利昔单抗治疗 irAEs 的连续患者。为了评估肝毒性，我们比较了英夫利昔单抗治疗前后 ALT、AST 和总胆红素（BT）的平均值。我们使用逻辑回归来评估与英夫利昔单抗疗效相关的因素。
在 2010 年 1 月至 2019 年 2 月期间，共确定了 56 名患者。患者的中位年龄为 63 岁（27-84 岁）。结肠炎是最常见的毒性（66%），其次是肺炎（11%）。英夫利昔单抗用于治疗 1 例 ir-hepatitis。英夫利昔单抗的中位剂量为 1（1-3），43 名（76%）患者的毒性得到缓解。英夫利昔单抗治疗前后 ALT、AST 和 BT 水平无统计学差异。治疗 ir-hepatitis 的患者完全恢复，无肝毒性增加。
在这种剂量限制的情况下，英夫利昔单抗在解决 irAEs 方面是有效的，并且不会引起肝毒性。
