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Related Experiment Video

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Immune Checkpoint Inhibitor-Induced Hepatitis: A Case Report of Challenging Management.

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  • 1Medical Oncology, Portuguese Institute of Oncology Francisco Gentil, Porto, PRT.

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|February 12, 2025
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Summary

Pembrolizumab can cause severe immune-mediated hepatitis in lung cancer patients. Combination therapy with mycophenolate mofetil and ursodeoxycholic acid successfully normalized liver function in a refractory case.

Keywords:
checkpoint inhibitor-induced liver injuryimmune-checkpoint inhibitorsimmune-related adverse eventslung cancersteroids and immunosuppressants

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Area of Science:

  • Oncology
  • Immunology
  • Hepatology

Background:

  • Pembrolizumab, an immune checkpoint inhibitor (ICI), improves outcomes in advanced lung cancer.
  • Immune-related adverse events (irAEs) are emerging challenges with ICI therapy.
  • Immune-mediated hepatitis is a significant, though less common, irAE that can be severe and refractory.

Observation:

  • A 67-year-old male with non-small cell lung cancer developed severe hepatitis after two cycles of pembrolizumab.
  • The hepatitis was refractory to corticosteroid treatment.
  • Liver biopsy confirmed hepatitis and cholestasis.

Findings:

  • Mycophenolate mofetil (MMF) was added for persistent cytolysis.
  • Ursodeoxycholic acid (UDCA) was introduced for persistent cholestasis.
  • Combination therapy with MMF and UDCA led to normalization of laboratory parameters.

Implications:

  • This case highlights a successful treatment strategy for severe, corticosteroid-refractory immune-mediated hepatitis.
  • The findings suggest MMF and UDCA as potential options for managing refractory ICI-induced liver injury.
  • Further prospective studies are needed to establish optimal treatment guidelines for immune-mediated hepatitis.