Pembrolizumab-associated immune-related hepatitis: a retrospective case report analysis
Ke-Qian Chen1, Yang Chen2, Jing-Fu Peng3
1Department of Clinical Pharmacy, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, China.
Frontiers in Medicine
|July 2, 2026
Summary
Pembrolizumab can cause immune-related hepatitis, with varied onset and symptoms. Early monitoring and corticosteroid treatment are key for managing this side effect in cancer patients.
Area of Science:
- Immunology
- Hepatology
- Oncology
Background:
- Pembrolizumab is an immune checkpoint inhibitor used in cancer therapy.
- Immune-related adverse events (irAEs) are known complications of pembrolizumab therapy.
- Immune-related hepatitis is a serious irAE that requires careful management.
Purpose of the Study:
- To analyze the clinical characteristics, mechanisms, and treatment of pembrolizumab-induced immune-related hepatitis.
- To improve clinical management and safety of pembrolizumab treatment.
Main Methods:
- Systematic review of case reports on pembrolizumab-induced immune-related hepatitis.
- Data extraction and analysis of patient demographics, clinical presentation, liver injury markers, and treatment outcomes from 42 case reports.
Main Results:
- Immune-related hepatitis occurred in patients with a mean age of 64.2 years (27 males, 14 females).
- Clinical manifestations included liver toxicity, neurological, skin, systemic, and digestive symptoms.
- Hepatitis onset ranged from 2 to 630 days after pembrolizumab initiation; corticosteroids were the primary treatment.
Conclusions:
- Pembrolizumab-induced immune-related hepatitis pathogenesis may involve dysregulated liver immune tolerance.
- Pre-treatment evaluation of liver function and concurrent medications is crucial.
- Regular liver function monitoring during pembrolizumab therapy is recommended for prompt management.
