Drug induced liver injury by immunotherapy

Immunotherapy has become the cornerstone of treatment of many malignancies. Check point inhibitors (CPIs) have been shown to be able to halt the progression of several types of advanced malignancies such as malignant melanoma and even keep patients in longstanding clinical remission (1-2). Thus, the use of CPIs has shown a substantial therapeutic benefit marked by signficant improvement in patient survival. However, this efficacy comes with a cost of several immune associated adverse effects due to the corollary reduction of immune self-tolerance. These adverse can be manifested as gastrointestinal symptoms (colitis), dermatological (dermatitis), lung symptoms (pneumonitis), endocrine manifestations (hypophysitis), apart from drug-induced liver injury (DILI), which is the focus of this editorial. Among 100 DILI patients due to CPIs of whom 53% had advanced melanoma, 45% had concomitant immune-mediated adverse effects, with dermatological (14%) and colitis (9%) being the most common (3).