Acute liver injury associated with rechallenge with a different type of immune checkpoint inhibitor in a patient with a history of severe immune-related adverse events

Iwamoto Takayuki, Nozaki Yasutoshi, Tsuji Shunsuke, Hukusima Hiroko, Yamauchi Ryohei, Nakanishi Ryota, Nagahama Shogo, Sunaga Koji, Yamaoka Sho, Suda Takahiro, Mizumoto Rui, Arimoto Yuki, Ohta Takashi, Yamaguchi Shinjiro, Ito Yoshiki, Paku Jyongon, Sudo Yoshiko, Nagano Teruaki, Yoshimura Michiko, Yamamoto Aya, Toda Michihito, Iwata Takashi, Hagiwara Hideki, Hayashi Norio

doi:10.2957/kanzo.61.572

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Other Title

抗PD-1抗体と抗PD-L1抗体のそれぞれの投与において免疫関連肝障害が発現した1例
症例報告抗PD-1抗体と抗PD-L1抗体のそれぞれの投与において免疫関連肝障害が発現した1例
ショウレイホウコクコウPD-1 コウタイトコウPD-L1 コウタイノソレゾレノトウヨニオイテメンエキカンレンカンショウガイガハツゲンシタ 1レイ

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Abstract

<p>A 59-year-old man with advanced non-small-cell lung cancer (NSCLC) developed acute liver injury 35 days after receiving pembrolizumab. There was no evidence of another cause for the hepatitis. Liver biopsy revealed interface hepatitis and CD8-positive lymphocyte infiltration in the portal area and liver parenchyma. Pembrolizumab-induced liver injury, which is a type of immune-related adverse event (irAE), was diagnosed. He received a combination of corticosteroid and mycophenolate mofetil (MMF), as his condition was refractory to corticosteroids. He then he received atezolizumab treatment for NSCLC. Eight days after initiation of atezolizumab, he relapsed. As the histological findings were similar to the first liver biopsy, he was diagnosed with atezolizumab-induced liver injury. A combination of corticosteroid and MMF achieved remission. The advisability of rechallenging with immune checkpoint inhibitors in patients with a history of severe irAE is controversial. We recommend careful monitoring of such patients to ensure early detection of irAE.</p>

Journal

Kanzo

Kanzo 61 (11), 572-581, 2020-11-01

The Japan Society of Hepatology

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