Department of Clinical Immunology and Allergy, Flinders Medical Centre, Bedford Park, 5042, Australia.
School of Medicine and Public Health, Flinders University, Bedford Park, 5042, Australia.
Immunotherapy. 2023 Oct;15(14):1125-1132. doi: 10.2217/imt-2023-0085. Epub 2023 Jul 4.
First- and second-line treatments for immune checkpoint inhibitor-related hepatotoxicity (IRH) are well established; however, evidence for third-line therapies is limited. We present a 68-year-old female with relapsed metastatic non-small-cell lung carcinoma despite multiple treatments. A fortnight after the second cycle of CTLA-4 inhibitor immunotherapy, she developed scleral icterus and mild jaundice with significant elevation in liver enzymes. A diagnosis of IRH was made, and despite corticosteroids, mycophenolate and tacrolimus, liver enzymes continued to worsen. One infusion of tocilizumab was given, which resulted in a remarkable improvement. Prednisolone and tacrolimus were then tapered over the ensuing months, and mycophenolate was continued. Given the rapid improvement in liver enzymes with tocilizumab, this treatment should be considered as a third-line treatment in IRH.
一线和二线治疗免疫检查点抑制剂相关肝毒性(IRH)已经得到充分确立;然而,三线治疗的证据有限。我们报告了一位 68 岁女性,尽管接受了多种治疗,但仍出现复发性转移性非小细胞肺癌。在 CTLA-4 抑制剂免疫治疗的第二个周期后两周,她出现巩膜黄疸和轻度黄疸,肝酶显著升高。诊断为 IRH,尽管使用了皮质类固醇、霉酚酸酯和他克莫司,但肝酶仍继续恶化。给予托珠单抗输注,结果显著改善。随后几个月逐渐减少泼尼松龙和他克莫司,并继续使用霉酚酸酯。鉴于托珠单抗可迅速改善肝酶,因此应将其视为 IRH 的三线治疗。