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Published on: November 8, 2015
Clinical Outcomes of Gradual Corticosteroid Tapering for Immune Checkpoint Inhibitor-Induced Liver Injury
Naoto Soma1, Yoshihito Uchida1, Kayoko Sugawara1
1Department of Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan.
Summary
A gradual corticosteroid tapering strategy effectively manages immune checkpoint inhibitor (ICI)-induced liver injury, preventing relapse and enabling safe ICI rechallenge in most patients.
Area of Science:
- Oncology
- Immunology
- Hepatology
Background:
- Immune checkpoint inhibitor (ICI)-induced liver injury is a significant adverse event impacting cancer therapy.
- Current corticosteroid tapering strategies lack established guidelines for preventing relapse and facilitating ICI rechallenge.
- This study addresses the need for an optimized tapering protocol.
Purpose of the Study:
- To evaluate the clinical outcomes of an empirical gradual corticosteroid tapering strategy for ICI-induced liver injury.
- To assess the efficacy of this strategy in preventing relapse and enabling subsequent ICI rechallenge.
- To inform clinical practice regarding the management of ICI-induced liver injury.
Main Methods:
- Retrospective analysis of 36 patients with grade ≥ 3 ICI-induced liver injury.
- Gradual prednisolone (PSL) tapering (5 mg every 2 weeks) initiated at 0.8 mg/kg/day.
- Selective use of steroid pulse therapy for severe cases; primary endpoint was relapse during tapering.
Main Results:
- 97% of patients (35/36) showed improvement in liver injury.
- Relapse occurred in only 3% (1/36) during tapering; no additional immunosuppressants were needed.
- ICI rechallenge in 13 patients (6 with grade 4 injury) resulted in only 8% (1/13) recurrence.
Conclusions:
- An empirical gradual corticosteroid tapering strategy, informed by AIH management, effectively prevents relapse of ICI-induced liver injury.
- This approach facilitates safe and successful ICI rechallenge in a majority of patients.
- The findings support the adoption of this tapering strategy in clinical practice.
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