Hepatobiliary and Pancreatic Adverse Events

Area of Science:

• Oncology
• Immunology
• Hepatology

Background:

• Immune checkpoint inhibitors (ICIs) have expanded cancer treatment options, improving survival.
• Hepatotoxicity is a significant immune-related adverse event (irAE) of ICIs, classified as drug-induced liver injury (DILI), with incidence up to 30%.

Purpose of the Study:

• To review the clinical presentation, diagnosis, and management of ICI-mediated hepatobiliary toxicity (IMH).
• To discuss ICI-associated cholangiopathic disease, cholecystitis, and pancreatic injury.
• To highlight the need for pharmacovigilance and potential alternative management strategies.

Main Methods:

• Review of clinical presentation, diagnostic criteria, and management guidelines for IMH.
• Analysis of ICI-related cholangiopathy, cholecystitis, and pancreatic injury.
• Discussion of current treatment recommendations versus clinical experience.

Main Results:

• IMH often presents as asymptomatic transaminase elevations, but can lead to liver failure.
• Diagnosis requires excluding other causes of hepatitis.
• Management involves ICI discontinuation and immunosuppression, with potential for alternative corticosteroid dosing and ICI re-challenge.

Conclusions:

• ICI-mediated hepatobiliary toxicity requires vigilant monitoring and tailored management.
• ICI-associated cholangiopathic disease and pancreatic injury present unique challenges.
• Clinical experience suggests flexibility in management and re-challenge strategies beyond current guidelines.