Tacrolimus for the Management of Delayed Onset and Treatment-Refractory Immune-Related Hepatitis.

Immune checkpoint inhibitors, such as pembrolizumab, are effective in the management of metastatic malignancies, such as melanoma, and are associated with a spectrum of immune-related organ toxicities, including immune-related hepatitis (ir-hepatitis). The clinical presentation of ir-hepatitis varies in onset and severity, and management involves immunosuppression with corticosteroids and mycophenolate mofetil as first and second-line agents. Several agents have been proposed as third-line options for treatment-refractory disease. We report the successful use of tacrolimus for delayed onset and treatment-refractory ir-hepatitis secondary to pembrolizumab.