Nakatani Saho, Fukushima Munehisa, Akahani Shiro
Otolaryngology and Head and Neck Surgery, Kansai Medical Hospital, Toyonaka, JPN.
Otolaryngology and Head and Neck Surgery, Tokyo Women's Medical University, Tokyo, JPN.
Cureus. 2024 Jul 16;16(7):e64703. doi: 10.7759/cureus.64703. eCollection 2024 Jul.
The immune checkpoint inhibitor pembrolizumab is now considered a first-line treatment for recurrent or metastatic head and neck squamous cell cancer. Pembrolizumab is less toxic than conventional chemotherapy but may result in immune-related adverse events. We report a case in which liver injury occurred just two days after the administration of pembrolizumab plus chemotherapy. A 48-year-old woman achieved a complete response after chemoradiotherapy for cT2N3bM0 squamous cell carcinoma of the oropharynx with multiple lymph node metastases. However, the tumor recurred one year later, and she was started on pembrolizumab plus chemotherapy. On day 3, her alanine aminotransferase and aspartate transaminase concentrations markedly increased. She was initially diagnosed with drug-induced liver injury and all medications were withdrawn. Her liver function recovered within two weeks without intervention. The lymphocyte transformation test was only positive for pembrolizumab. Clinicians should consider pembrolizumab-induced allergic hepatitis as a possible cause of liver injury after excluding liver metastasis and immune-related adverse events.
免疫检查点抑制剂帕博利珠单抗目前被认为是复发性或转移性头颈部鳞状细胞癌的一线治疗药物。帕博利珠单抗的毒性低于传统化疗，但可能导致免疫相关不良事件。我们报告一例在使用帕博利珠单抗联合化疗仅两天后发生肝损伤的病例。一名48岁女性在接受放化疗后，cT2N3bM0口咽鳞状细胞癌伴多发淋巴结转移达到完全缓解。然而，一年后肿瘤复发，她开始接受帕博利珠单抗联合化疗。在第3天，她的丙氨酸转氨酶和天冬氨酸转氨酶浓度显著升高。她最初被诊断为药物性肝损伤，所有药物均被停用。未经干预，她的肝功能在两周内恢复。淋巴细胞转化试验仅对帕博利珠单抗呈阳性。临床医生在排除肝转移和免疫相关不良事件后，应考虑帕博利珠单抗诱导的过敏性肝炎是肝损伤的可能原因。
