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Checkpoint inhibitor hepatotoxicity: pathogenesis and management.
Morven Cunningham1, Rohit Gupta1, Marcus Butler2
1Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.
Immune checkpoint inhibitor (ICI) therapy revolutionizes cancer treatment but can cause liver damage (hepatotoxicity). Management strategies are evolving beyond corticosteroids to address severe or atypical cases and their impact on cancer outcomes.
Area of Science:
- Oncology
- Immunology
- Hepatology
Background:
- Immune checkpoint inhibitors (ICIs) offer durable cancer responses but can cause immune-mediated tissue damage.
- Hepatotoxicity is a significant side effect of ICI therapy, affecting 2%-25% of patients, and presents with varying severity.
- Current management relies on corticosteroids, but a subset of patients shows poor response, necessitating alternative strategies.
Conclusions:
- Evolving management should aim to limit corticosteroid exposure and address rare presentations like cholestatic hepatitis and liver failure.
- Understanding hepatotoxicity's impact on cancer treatment and the safety of re-challenging with ICIs is crucial for patients with advanced malignancy.
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