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A systematic review and meta-analysis of immune-mediated liver dysfunction in non-small cell lung cancer

Lan-Lan Lin1, Guo-Fu Lin2, Fan Yang1

  • 1Department of Respiratory Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, People's Republic of China.

International Immunopharmacology
|May 7, 2020
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) increase the risk of liver dysfunction in non-small cell lung cancer (NSCLC) patients. Combination therapy with chemotherapy further elevates this risk, necessitating careful monitoring.

Area of Science:

  • Oncology
  • Immunology
  • Hepatology

Background:

  • Immune checkpoint inhibitors (ICIs) are established treatments for non-small cell lung cancer (NSCLC).
  • Immune-related adverse events (irAEs), including liver dysfunction, are common complications of ICI therapy.
  • The incidence and risk of ICI-induced liver injury in NSCLC patients require comprehensive evaluation.

Purpose of the Study:

  • To systematically review and meta-analyze the incidence and risk of immune-mediated liver dysfunction in NSCLC patients treated with ICIs.
  • To compare the risk of liver injury between ICI therapy and chemotherapy.
  • To assess the impact of combination ICI and chemotherapy on liver-related adverse events.

Main Methods:

  • Systematic literature search of PubMed, Cochrane Library, Embase, and ClinicalTrials.gov up to December 2019.
  • Inclusion of clinical trials reporting all-grade (1-5) and high-grade (3-5) hepatitis and ALT or AST elevation.
  • Meta-analysis of data from 11 clinical trials involving 7086 patients.

Main Results:

  • Overall incidence of ALT elevation, AST elevation, and hepatitis with ICIs was 6.18%, 4.99%, and 1.09%, respectively.
  • ICIs significantly increased the risk of all-grade (RR: 7.27) and high-grade (RR: 6.70) hepatitis compared to chemotherapy.
  • Combination ICI and chemotherapy showed a higher relative risk of all-grade hepatitis (RR: 7.89) than monotherapy (RR: 6.94).

Conclusions:

  • ICI treatment is associated with a higher incidence and risk of immune-induced liver dysfunction in NSCLC patients.
  • Combination immunotherapy and chemotherapy may increase the risk of hepatic adverse events compared to monotherapy.
  • Clinicians must promptly recognize and manage ICI-induced liver injury to prevent severe hepatic complications.
Keywords:
ALT/AST elevationHepatitisImmune checkpoint inhibitorsNon-small cell lung cancer

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