Hayashi Anna, Nakamichi Shinji, Nakayama Yukako, Nagano Atsuhiro, Mikami Erika, Takano Natsuki, Tozuka Takehiro, Matsumoto Masaru, Miyanaga Akihiko, Noro Rintaro, Terasaki Yasuhiro, Kubota Kaoru, Seike Masahiro, Gemma Akihiko
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Bunkyo-ku, Japan.
Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Bunkyo-ku, Japan.
Onco Targets Ther. 2022 Jun 7;15:637-642. doi: 10.2147/OTT.S361467. eCollection 2022.
Pembrolizumab is an immune checkpoint inhibitor (ICI) that targets programmed death-1. Although ICIs have shown efficacy in the treatment of lung cancer, they have also been reported to cause a variety of immune-related adverse events (irAEs). Hepatotoxicity is a known irAEs, but currently, there is not enough information on its pathological characteristics and treatment. We report the case of a 70-year-old man with advanced squamous-cell lung cancer who developed severe grade 4 hepatitis on day 8 after receiving carboplatin, nab-paclitaxel, and pembrolizumab as fourth-line therapy. We treated him with steroid therapy the day after a liver biopsy was performed to investigate his pathological features, which led to a rapid and remarkable improvement. Confirmation of immune-related hepatotoxicity by pathological findings allowed the early tapering and discontinuation of steroid therapy. Performing a liver biopsy and verifying histological characteristics are needed for successful treatment with short-term steroids when drug-induced hepatitis caused by anti-cancer therapy including pembrolizumab is considered.
帕博利珠单抗是一种靶向程序性死亡-1的免疫检查点抑制剂（ICI）。尽管ICI在肺癌治疗中已显示出疗效，但也有报道称它们会引起各种免疫相关不良事件（irAE）。肝毒性是一种已知的irAE，但目前关于其病理特征和治疗的信息还不够。我们报告了一例70岁晚期鳞状细胞肺癌男性患者的病例，该患者在接受卡铂、白蛋白结合型紫杉醇和帕博利珠单抗作为四线治疗后的第8天出现了严重的4级肝炎。在进行肝活检以研究其病理特征后的第二天，我们对他进行了类固醇治疗，这导致了病情迅速且显著的改善。通过病理结果证实免疫相关肝毒性后，类固醇治疗得以早期减量并停药。当考虑由包括帕博利珠单抗在内的抗癌治疗引起的药物性肝炎时，为了使用短期类固醇成功治疗，需要进行肝活检并验证组织学特征。
