Liu Chaoxia, Li Xinchun, Deng Yuping
Hunan Cancer Hospital, The Affiliated Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
Front Oncol. 2025 Aug 22;15:1604601. doi: 10.3389/fonc.2025.1604601. eCollection 2025.
Tislelizumab, an anti-PD-1 monoclonal antibody, is associated with immune-related hepatitis in 1.8% of cases, but reports of acute liver failure (ALF) remain exceedingly rare. We present a case of fulminant hepatitis and ALF following Tislelizumab therapy in a 55-year-old woman with locally advanced cervical adenocarcinoma. After three cycles of concurrent chemoradiotherapy and Tislelizumab, she developed grade 4 immune-mediated hepatitis and ALF following a fourth Tislelizumab dose, marked by severe transaminitis (AST 5329 U/L, ALT 2384 U/L), coagulopathy (INR 5.85), hyperbilirubinemia (TBIL 56.99 IU/L), and hepatic encephalopathy. Management included plasma exchange, continuous hemofiltration, high-dose corticosteroids, and immunosuppressive agents. Despite aggressive intervention, the patient's condition deteriorated, underscoring the rapid progression of Tislelizumab-induced hepatotoxicity. This case highlights the critical need for vigilant monitoring of high-risk patients receiving immune checkpoint inhibitors and early intervention for suspected immune-mediated liver injury.
替雷利珠单抗是一种抗程序性死亡蛋白1（PD-1）单克隆抗体，1.8%的病例会出现免疫相关肝炎，但急性肝衰竭（ALF）的报道极为罕见。我们报告了一例55岁局部晚期宫颈腺癌女性在接受替雷利珠单抗治疗后发生暴发性肝炎和ALF的病例。在同步放化疗和替雷利珠单抗治疗三个周期后，她在第四次使用替雷利珠单抗后出现4级免疫介导性肝炎和ALF，表现为严重转氨酶升高（谷草转氨酶5329 U/L，谷丙转氨酶2384 U/L）、凝血功能障碍（国际标准化比值5.85）、高胆红素血症（总胆红素56.99 IU/L）和肝性脑病。治疗措施包括血浆置换、持续血液滤过、大剂量糖皮质激素和免疫抑制剂。尽管进行了积极干预，患者病情仍恶化，这突出了替雷利珠单抗所致肝毒性的快速进展。该病例强调了对接受免疫检查点抑制剂的高危患者进行密切监测以及对疑似免疫介导性肝损伤进行早期干预的迫切需求。
