Baumert Lukas S, Shih Angela R, Chung Raymond T
Liver Center, Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany.
Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Med. 2024 Feb 9;5(2):126-131.e1. doi: 10.1016/j.medj.2024.01.002.
Immune checkpoint inhibitor (ICI)-related liver injury is a growing concern as ICIs are increasingly used in cancer treatment regimens. Interestingly, ICIs have exhibited antiviral effects among patients with chronic hepatitis B virus (HBV). However, the underlying mechanisms remain unclear, and clinical data on patients with previous HBV infection/exposure and isolated anti-HBV core antibodies (IAHBcs) are lacking.
We report a case illustrating the dual effects of ICIs in a patient experiencing panlobular hepatitis and concurrent HBV reactivation.
A 68-year-old male patient positive for IAHBcs was admitted with panlobular hepatitis and HBV reactivation after receiving systemic chemotherapy (several months before admission) and ICI treatment (4 weeks before admission) subsequent to metastatic primary lung cancer (NSCLC stage IV). This was followed by a rapid and significant decrease of HBV DNA viral load before and during antiviral treatment.
This unique case sheds light on the dynamics of ICI therapy in IAHBc-positive patients experiencing HBV reactivation during chemotherapy and underscores the dual impact of ICIs. Moreover, it emphasizes the need for assessment of HBV serology and prophylaxis in IAHBc-positive patients undergoing chemotherapy and ICI treatment.
R.T.C. was supported by the MGH Research Scholars Program.
随着免疫检查点抑制剂（ICI）越来越多地用于癌症治疗方案，与ICI相关的肝损伤日益受到关注。有趣的是，ICI在慢性乙型肝炎病毒（HBV）患者中显示出抗病毒作用。然而，其潜在机制仍不清楚，且缺乏关于既往有HBV感染/暴露史且仅抗-HBV核心抗体（IAHBc）阳性患者的临床数据。
我们报告一例病例，说明ICI在一名患有全小叶性肝炎并同时发生HBV再激活患者中的双重作用。
一名IAHBc阳性的68岁男性患者，在转移性原发性肺癌（IV期非小细胞肺癌）后接受全身化疗（入院前数月）和ICI治疗（入院前4周）后，因全小叶性肝炎和HBV再激活入院。随后，在抗病毒治疗前及治疗期间，HBV DNA病毒载量迅速且显著下降。
这一独特病例揭示了IAHBc阳性患者在化疗期间发生HBV再激活时ICI治疗的动态变化，并强调了ICI的双重影响。此外，它强调了对接受化疗和ICI治疗的IAHBc阳性患者进行HBV血清学评估和预防的必要性。
R.T.C.得到了MGH研究学者计划的支持。
