Diagnosis and Management of Immune-Mediated Hepatotoxicity from Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICIs) are a breakthrough immunotherapy for the treatment of many advanced malignancies. However, they can cause inflammatory side effects that most commonly affect endocrine glands, skin, gastrointestinal tract, and liver. The following are highlights from a comprehensive, evidence-based review of immune-mediated hepatotoxicity (IMH):

• Incidence of IMH ranges from 0.7% to 16%; severe IMH occurs in 0.6% to 11% and rare cases of fulminant liver failure in 0.1% to 0.2%.

• Risk factors are prior autoimmune disease, prior reaction to any class of ICIs, use of higher dose of ICI, and use of combined ICIs.

• Onset typically occurs 4 to 12 weeks after beginning ICI therapy; normalization of liver tests occurs 8 to 104 days aft…