A Case Report of Successful Treatment of Severe Immunotherapy-related Hepatitis in a Patient with advanced Lung Squamous-cell carcinoma

Abstract

Abstract In the last decade, the use of immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) and its ligand (PD-L1) has significantly improved prognosis of patients with advanced malignant tumors (1). But immunotherapy-related adverse events (irAEs) were observed more often in the process of treatment(2). Immunotherapy-related adverse events may impair many organs, including endocrine system, skin, heart, lung, and liver. Though infrequent, irAEs may induce severe outcomes and influence subsequent therapy of cancer. Immunotherapy-related hepatitis (IRH) is one of the major irAEs. Reported incidence of IRH varies from 0.7–16%(3). Immunosuppressants are often considered when glucocorticoid does not respond well in treatment of IRH. There were reports of effective use of mycophenolate mofetil(4) and tacrolimus(5)in treatment of IRH. Infliximab is contraindicated for the treatment of IRH due to the risk of inducing further liver damage(6–8). However, benefits of these agents are uncertain when satisfactory effect of sufficient steroid was not seen. Reason may lie in complex situation of steroid resistant IRH. In this article, we reported a patient with lung squamous cell carcinoma who developed severe IRH after one cycle of PD-1 inhibitor. After comprehensive treatment of glucocorticoid, tofacitinib, artificial liver support system and other supportive treatments, the patient's liver function returned to normal.